Scheidtmann K, Fries W, Müller F, Koenig E
Neurologische Klinik, D-83043 Bad, Aibling, Germany.
Lancet. 2001 Sep 8;358(9284):787-90. doi: 10.1016/S0140-6736(01)05966-9.
Functional disability is generally caused by hemiplegia after stroke. Physiotherapy used to be the only way of improving motor function in such patients. However, administration of amphetamines in addition to exercise improves motor recovery in animals, probably by increasing the concentration of norepinephrine in the central nervous system. Our aim was to ascertain whether levodopa could enhance the efficacy of physiotherapy after hemiplegia.
We did a prospective, randomised, placebo-controlled, double-blind study in which we enrolled 53 primary stroke patients. For the first 3 weeks patients received single doses of levodopa 100 mg or placebo daily in combination with physiotherapy. For the second 3 weeks patients had only physiotherapy. We quantitatively assessed motor function every week with Rivermead motor assessment (RMA).
Six patients were excluded from analyses because of non-neurological complications. Motor recovery was significantly improved after 3 weeks of drug intervention in those on levodopa (RMA improved by 6.4 points) compared with placebo (4.1), and the result was independent of initial degree of impairment (p<0.004). The advantage of the levodopa group was maintained at study endpoint 3 weeks after levodopa was stopped. At the end of the study the total RMA score gain for the levodopa group was 8.2 points compared with 5.7 in the placebo group (p=0.020).
A single dose of levodopa is well tolerated and, when given in combination with physiotherapy, enhances motor recovery in patients with hemiplegia. In view of its minimal side-effects, levodopa will be a possible add- on during stroke rehabilitation.
功能障碍通常由中风后的偏瘫引起。物理治疗曾经是改善此类患者运动功能的唯一方法。然而，除运动外给予苯丙胺可改善动物的运动恢复，可能是通过增加中枢神经系统中去甲肾上腺素的浓度。我们的目的是确定左旋多巴是否能增强偏瘫后物理治疗的效果。
我们进行了一项前瞻性、随机、安慰剂对照、双盲研究，纳入了53例首次中风患者。在最初的3周内，患者每天接受单剂量100mg左旋多巴或安慰剂，并结合物理治疗。在接下来的3周内，患者仅接受物理治疗。我们每周用Rivermead运动评估（RMA）对运动功能进行定量评估。
6例患者因非神经并发症被排除在分析之外。与安慰剂组（改善4.1分）相比，接受左旋多巴治疗的患者在药物干预3周后运动恢复明显改善（RMA改善6.4分），且结果与初始损伤程度无关（p<0.004）。左旋多巴组的优势在停用左旋多巴3周后的研究终点得以维持。在研究结束时，左旋多巴组的RMA总得分增加8.2分，而安慰剂组为5.7分（p=0.020）。
单剂量左旋多巴耐受性良好，与物理治疗联合使用时可增强偏瘫患者的运动恢复。鉴于其副作用极小，左旋多巴可能成为中风康复期间的一种辅助药物。
