Barbay Scott, Nudo Randolph J
Department of Molecular and Integrative Physiology and Landon Center on Aging, Kansas University Medical Center, Kansas City, KS, USA.
NeuroRehabilitation. 2009;25(1):5-17. doi: 10.3233/NRE-2009-0495.
Therapeutic strategies to promote recovery from stroke are now beginning to utilize current knowledge of neural plasticity and the neuromodulatory role of physical rehabilitation. Current interests are also focused on adjuvant therapies that may enhance plasticity associated with recovery and rehabilitation. Amphetamine was one of the earliest pharmacological interventions and continues to show promising results as an adjuvant treatment for recovery of function in pre-clinical animal studies. This drug is a potent modulator of neurological function and cortical excitation, acting primarily through norepinephrine and dopamine mechanisms to enhance arousal and attention, and thus, to facilitate learning of motor skills. Although the results from the pre-clinical studies have been primarily positive, they have not translated well to clinical trials, which have yielded mixed results. This review addresses some of the conflicting evidence from pre-clinical studies conducted between 1982 and 2008 in order to better understand how to optimize the clinical application of amphetamine as an adjuvant therapy for stroke recovery. Among many of the factors that relate to differences in outcome, it is likely that both amphetamine dose and the timing of the intervention with respect to the time of injury affected the outcome.
促进中风恢复的治疗策略如今开始利用当前关于神经可塑性以及物理康复的神经调节作用的知识。当前的研究兴趣还集中在可能增强与恢复和康复相关的可塑性的辅助疗法上。苯丙胺是最早的药物干预措施之一，在临床前动物研究中作为功能恢复的辅助治疗继续显示出有前景的结果。这种药物是神经功能和皮层兴奋的有效调节剂，主要通过去甲肾上腺素和多巴胺机制起作用，以增强觉醒和注意力，从而促进运动技能的学习。尽管临床前研究的结果主要是积极的，但它们在临床试验中并未得到很好的转化，临床试验产生了好坏参半的结果。这篇综述探讨了1982年至2008年间进行的临床前研究中的一些相互矛盾的证据，以便更好地理解如何优化苯丙胺作为中风恢复辅助疗法的临床应用。在与结果差异相关的许多因素中，苯丙胺剂量以及干预相对于损伤时间的时机可能都影响了结果。
