Fluoxetine enhances motor recovery after acute ischaemic stroke

January 01, 0001

Fluoxetine enhances motor recovery after acute ischaemic stroke

Hemiplegia and hemiparesis are the most common deficits caused by stroke. A few small clinical trials suggest that fluoxetine enhances motor recovery but its clinical efficacy is unknown. The researchers from France therefore aimed to investigate whether fluoxetine would enhance motor recovery if given soon after an ischaemic stroke to patients who have motor deficits. In this double-blind, placebo-controlled trial, patients from nine stroke centres in France who had ischaemic stroke and hemiplegia or hemiparesis, had Fugl-Meyer motor scale (FMMS) scores of 55 or less, and were aged between 18 years and 85 years were eligible for inclusion. Patients were randomly assigned, using a computer random-number generator, in a 1:1 ratio to fluoxetine (20 mg once per day, orally) or placebo for 3 months starting 5—10 days after the onset of stroke. All patients had physiotherapy. 118 patients were randomly assigned to fluoxetine (n=59) or placebo (n=59), and 113 were included in the analysis (57 in the fluoxetine group and 56 in the placebo group). Two patients died before day 90 and three withdrew from the study.

FMMS improvement at day 90 was significantly greater in the fluoxetine group (adjusted mean 34.0 points) than in the placebo group (24.3 points). The main adverse events in the fluoxetine and placebo groups were hyponatraemia (4% vs 4%), transient digestive disorders including nausea, diarrhoea, and abdominal pain (25% vs 11%), hepatic enzyme disorders (9% vs 18%), psychiatric disorders (5% vs 7%), insomnia (33% vs 36%), and partial seizure (less than 1% vs 0).

The researchers concluded: "In patients with ischaemic stroke and moderate to severe motor deficit, the early prescription of fluoxetine with physiotherapy enhanced motor recovery after 3 months. Modulation of spontaneous brain plasticity by drugs is a promising pathway for treatment of patients with ischaemic stroke and moderate to severe motor deficit."

Fascinating addition to the concept of brain plasticity.

For the full abstract, click here.

The Lancet Neurology published online 10 January 2011 © 2011 Elsevier Limited
Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. François Chollet, Jean Tardy, Jean-François Albucher et al. Correspondence to François Chollet: [email protected]

Category: N. Neurological. Keywords: fluoxetine, motor recovery, acute ischaemic stroke, double-blind, placebo-controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 28 January 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.