Dam M, Tonin P, De Boni A, Pizzolato G, Casson S, Ermani M, Freo U, Piron L, Battistin L
Department of Neurological and Vision Sciences, University of Verona, Italy.
Stroke. 1996 Jul;27(7):1211-4. doi: 10.1161/01.str.27.7.1211.
In animals, drugs that increase brain amine concentrations influence the rate and degree of recovery from cortical lesions. It is therefore conceivable that antidepressants may influence outcome after ischemic brain injury in humans. We evaluated the effects of the norepinephrine reuptake blocker maprotiline and the serotonin reuptake blocker fluoxetine on the motor/functional capacities of poststroke patients undergoing physical therapy.
Fifty-two severely disabled hemiplegic subjects were randomly assigned to three treatment groups; during 3 months of physical therapy, patients were treated with placebo, maprotiline (150 mg/d), or fluoxetine (20 mg/d). Before and at the end of the observation period, we assessed activities of daily living by the Barthel Index, degree of neurological deficit by a neurological scale for hemiplegic subjects, and depressive symptomatology by the Hamilton Depression Rating Scale.
The diverse treatments ameliorated walking and activities of daily living capacities to different extents. The greatest improvements were observed in the fluoxetine-treated group and the lowest in the maprotiline-treated group. Furthermore, fluoxetine yielded a significantly larger number of patients with good recovery compared with maprotiline or placebo. These effects of the drugs were not related to their efficacy in treating depressive symptoms.
Fluoxetine may facilitate or, alternatively, maprotiline may hinder recovery in poststroke patients undergoing rehabilitation. The effects of fluoxetine as an adjunct to physical therapy warrant further investigation, since treatment with fluoxetine may result in a better functional outcome from stroke than physical therapy alone.
在动物实验中，能提高脑胺浓度的药物会影响皮质损伤后的恢复速度和程度。因此可以推测，抗抑郁药可能会影响人类缺血性脑损伤后的预后。我们评估了去甲肾上腺素再摄取阻滞剂马普替林和5-羟色胺再摄取阻滞剂氟西汀对接受物理治疗的中风后患者运动/功能能力的影响。
52名严重残疾的偏瘫患者被随机分为三个治疗组；在为期3个月的物理治疗期间，患者分别接受安慰剂、马普替林（150毫克/天）或氟西汀（20毫克/天）治疗。在观察期开始前和结束时，我们通过巴氏指数评估日常生活活动能力，通过偏瘫患者神经量表评估神经功能缺损程度，通过汉密尔顿抑郁量表评估抑郁症状。
不同治疗方法在不同程度上改善了行走和日常生活活动能力。氟西汀治疗组改善最为明显，马普替林治疗组改善最小。此外，与马普替林或安慰剂相比，氟西汀治疗后恢复良好的患者数量显著更多。这些药物的效果与其治疗抑郁症状的疗效无关。
氟西汀可能促进中风后康复患者的恢复，而马普替林可能会阻碍恢复。氟西汀作为物理治疗辅助手段的效果值得进一步研究，因为与单纯物理治疗相比，氟西汀治疗可能会使中风患者获得更好的功能预后。
