UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
Brain. 2012 Aug;135(Pt 8):2478-91. doi: 10.1093/brain/aws154. Epub 2012 Jul 2.
Hemispatial neglect following right-hemisphere stroke is a common and disabling disorder, for which there is currently no effective pharmacological treatment. Dopamine agonists have been shown to play a role in selective attention and working memory, two core cognitive components of neglect. Here, we investigated whether the dopamine agonist rotigotine would have a beneficial effect on hemispatial neglect in stroke patients. A double-blind, randomized, placebo-controlled ABA design was used, in which each patient was assessed for 20 testing sessions, in three phases: pretreatment (Phase A1), on transdermal rotigotine for 7-11 days (Phase B) and post-treatment (Phase A2), with the exact duration of each phase randomized within limits. Outcome measures included performance on cancellation (visual search), line bisection, visual working memory, selective attention and sustained attention tasks, as well as measures of motor control. Sixteen right-hemisphere stroke patients were recruited, all of whom completed the trial. Performance on the Mesulam shape cancellation task improved significantly while on rotigotine, with the number of targets found on the left side increasing by 12.8% (P = 0.012) on treatment and spatial bias reducing by 8.1% (P = 0.016). This improvement in visual search was associated with an enhancement in selective attention but not on our measures of working memory or sustained attention. The positive effect of rotigotine on visual search was not associated with the degree of preservation of prefrontal cortex and occurred even in patients with significant prefrontal involvement. Rotigotine was not associated with any significant improvement in motor performance. This proof-of-concept study suggests a beneficial role of dopaminergic modulation on visual search and selective attention in patients with hemispatial neglect following stroke.
右侧半球卒中后偏侧忽略是一种常见且致残的疾病，目前尚无有效的药物治疗方法。多巴胺激动剂已被证明在选择性注意和工作记忆中起作用，而这两者是忽略的两个核心认知成分。在这里，我们研究了多巴胺激动剂罗替高汀是否对卒中患者的偏侧忽略有有益作用。采用双盲、随机、安慰剂对照的 ABA 设计，对每个患者进行 20 次测试，共分三个阶段：治疗前（A1 期）、经皮罗替高汀治疗 7-11 天（B 期）和治疗后（A2 期），每个阶段的确切持续时间在限制内随机。主要结局包括在取消（视觉搜索）、线二分、视觉工作记忆、选择性注意和持续性注意任务中的表现，以及运动控制的测量。共招募了 16 名右侧半球卒中患者，他们都完成了试验。在使用罗替高汀治疗时，Mesulam 形状取消任务的表现显著改善，左侧发现的目标数量增加了 12.8%（P=0.012），空间偏差减少了 8.1%（P=0.016）。视觉搜索的这种改善与选择性注意的增强有关，但与我们的工作记忆或持续性注意力测量无关。罗替高汀对视觉搜索的积极影响与前额叶皮层的保存程度无关，即使在前额叶叶严重受累的患者中也存在这种影响。罗替高汀与运动表现的任何显著改善均无关。这项概念验证研究表明，多巴胺能调制对卒中后偏侧忽略患者的视觉搜索和选择性注意具有有益作用。
