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左旋多巴增强卒中康复(ESTREL):一项随机安慰剂对照、双盲优效性试验的原理和设计。

Enhancement of STroke REhabilitation with Levodopa (ESTREL): Rationale and design of a randomized placebo-controlled, double blind superiority trial.

机构信息

Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland.

Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.

出版信息

Eur Stroke J. 2024 Dec;9(4):1093-1102. doi: 10.1177/23969873241255867. Epub 2024 Jun 9.


DOI:10.1177/23969873241255867
PMID:38853524
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11569567/
Abstract

RATIONALE: Novel therapeutic approaches are needed in stroke recovery. Whether pharmacological therapies are beneficial for enhancing stroke recovery is unclear. Dopamine is a neurotransmitter involved in motor learning, reward, and brain plasticity. Its prodrug levodopa is a promising agent for stroke recovery. AIM AND HYPOTHESIS: To investigate the hypothesis that levodopa, in addition to standardized rehabilitation therapy based on active task training, results in an enhancement of functional recovery in acute ischemic or hemorrhagic stroke patients compared to placebo. DESIGN: ESTREL (nhancement of troke habilitation with ) is a randomized (ratio 1:1), multicenter, placebo-controlled, double-blind, parallel-group superiority trial. PARTICIPANTS: 610 participants (according to sample size calculation) with a clinically meaningful hemiparesis will be enrolled ⩽7 days after stroke onset. Key eligibility criteria include (i) in-hospital-rehabilitation required, (ii) capability to participate in rehabilitation, (iii) previous independence in daily living. INTERVENTION: Levodopa 100 mg/carbidopa 25 mg three times daily, administered for 5 weeks in addition to standardized rehabilitation. The study intervention will be initiated within 7 days after stroke onset. COMPARISON: Matching placebo plus standardized rehabilitation. OUTCOMES: The primary outcome is the between-group difference of the Fugl-Meyer-Motor Assessment (FMMA) total score measured 3 months after randomization. Secondary outcomes include patient-reported health and wellbeing (PROMIS 10 and 29), patient-reported assessment of improvement, Rivermead Mobility Index, modified Rankin Scale, National Institutes of Health Stroke Scale (NIHSS), and as measures of harm: mortality, recurrent stroke, and serious adverse events. CONCLUSION: The ESTREL trial will provide evidence of whether the use of Levodopa in addition to standardized rehabilitation in stroke patients leads to better functional recovery compared to rehabilitation alone.

摘要

背景:在中风康复中需要新的治疗方法。尚不清楚药物治疗是否有助于增强中风康复。多巴胺是一种参与运动学习、奖励和大脑可塑性的神经递质。其前体药物左旋多巴是中风恢复的有希望的药物。 目的和假设:研究左旋多巴是否在基于主动任务训练的标准化康复治疗的基础上,与安慰剂相比,能使急性缺血性或出血性中风患者的功能恢复得到增强。 设计:ESTREL(用左旋多巴增强中风康复)是一项随机(比例为 1:1)、多中心、安慰剂对照、双盲、平行组优效性试验。 参与者:将招募 610 名(根据样本量计算)具有临床意义的偏瘫的患者,他们在中风发作后 ⩽7 天内入院。主要入选标准包括(i)需要住院康复,(ii)有能力参与康复,(iii)日常生活独立。 干预措施:左旋多巴 100mg/卡比多巴 25mg,每日 3 次,与标准化康复一起使用 5 周。研究干预将在中风发作后 7 天内开始。 比较:匹配安慰剂加标准化康复。 结局:主要结局是在随机分组后 3 个月测量的 Fugl-Meyer-Motor-Assessment(FMMA)总评分的组间差异。次要结局包括患者报告的健康和幸福感(PROMIS 10 和 29)、患者报告的改善评估、Rivermead 移动指数、改良 Rankin 量表、国立卫生研究院中风量表(NIHSS)以及作为伤害测量:死亡率、复发性中风和严重不良事件。 结论:ESTREL 试验将提供证据,证明在中风患者中,与单独康复相比,使用左旋多巴加标准化康复是否能导致更好的功能恢复。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d575/11585017/5100d333d1f9/10.1177_23969873241255867-img2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d575/11585017/5100d333d1f9/10.1177_23969873241255867-img2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d575/11585017/5100d333d1f9/10.1177_23969873241255867-img2.jpg

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[1]
Enhancement of STroke REhabilitation with Levodopa (ESTREL): Rationale and design of a randomized placebo-controlled, double blind superiority trial.

Eur Stroke J. 2024-12

[2]
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[3]
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[5]
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[6]
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[7]
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[8]
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[9]
Interrater reliability of the Fugl-Meyer Motor assessment in stroke patients: a quality management project within the ESTREL study.

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[10]
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引用本文的文献

[1]
Genomics of stroke recovery and outcome.

J Cereb Blood Flow Metab. 2025-4-11

本文引用的文献

[1]
Interrater reliability of the Fugl-Meyer Motor assessment in stroke patients: a quality management project within the ESTREL study.

Front Neurol. 2024-4-8

[2]
Why estimands are needed to define treatment effects in clinical trials.

BMC Med. 2023-7-27

[3]
Endogenous dopamine transmission is crucial for motor skill recovery after stroke.

IBRO Neurosci Rep. 2022-6-2

[4]
An Exercise Mimetic Approach to Reduce Poststroke Deconditioning and Enhance Stroke Recovery.

Neurorehabil Neural Repair. 2021-6

[5]
Estimating minimal clinically important differences for two scales in patients with chronic traumatic brain injury.

Curr Med Res Opin. 2020-12

[6]
Safety and efficacy of co-careldopa as an add-on therapy to occupational and physical therapy in patients after stroke (DARS): a randomised, double-blind, placebo-controlled trial.

Lancet Neurol. 2019-6

[7]
PROMIS-29 v2.0 profile physical and mental health summary scores.

Qual Life Res. 2018-3-22

[8]
Motor skill learning and reward consumption differentially affect VTA activation.

Sci Rep. 2018-1-12

[9]
Standardized measurement of sensorimotor recovery in stroke trials: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable.

Int J Stroke. 2017-7

[10]
Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce.

Int J Stroke. 2017-7

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