Affiliations: Section of Neurological Rehabilitation, Department of
Neurological and Visual Science, University of Verona, Policlinico
"Gianbattista Rossi", Verona, Italy
Note: [] Corresponding author: Paolo Manganotti, Sezione Neurologia
Riabilitativa, Dipartimento di Scienze Neurologiche e della Visione,
Universita' di Verona Policlinico "Gianbattista Rossi", P.zz.le LA Scuro,
Verona 37100, Italy. Tel.: +39 045 8124768; Fax: +39 045 8104472; E-mail:
paolo.manganotti@univr.it
Abstract: Purpose: Promising new rehabilitative approaches to improve the
substantial motor disability associated with chronic stroke include
pharmacotherapy to enhance motor recovery. We conducted a single-blind
placebo-controlled crossover pilot study to investigate the effects of
prolonged treatment with L-DOPA in stroke patients. Methods: Ten chronic (10–48 months) stroke patients received
placebo or L-DOPA 100 mg daily for 5 weeks. During drug's treatment patients
suspended physiotherapy. Patients underwent clinical evaluation (Rivermead
Motor Assessment, Nine Hole Peg Test, and 10 meter walking test) and
transcranial magnetic stimulation recordings from the affected and unaffected
hemisphere (resting motor threshold, motor evoked potential amplitude and
cortical silent period) before and after 5 weeks of treatment. Results: After L-DOPA treatment patients improved their walking
speed (p< 0.01) and manual dexterity (p< 0.01) with the affected hand,
the cortical silent period over the affected hemisphere lengthened (p<
0.01), while no changes were found in placebo-group. Conclusion: A 5-week course of oral L-DOPA in a single daily dose
substantially improves motor performance in patients with chronic stroke and
could do so by modulating motor cortical excitability (cortical silent period
lengthening) suggesting that cortical inhibitory mechanisms have a role in
motor recovery after stroke. Pharmacotherapy could be a useful therapeutic
approach for chronic stroke patients.
Keywords: Levodopa, stroke, rehabilitation, TMS, drug
