Grade C, Redford B, Chrostowski J, Toussaint L, Blackwell B
Department of Psychiatry, Milwaukee Clinical Campus, University of Wisconsin School of Medicine, USA.
Arch Phys Med Rehabil. 1998 Sep;79(9):1047-50. doi: 10.1016/s0003-9993(98)90169-1.
To determine the efficacy and safety of methylphenidate in acute stroke rehabilitation.
A prospective, randomized, double-blind, placebo-controlled study.
Twenty-one stroke patients consecutively admitted to a community-based rehabilitation unit.
Three-week treatment of methylphenidate (or placebo) in conjunction with physical therapy. Methylphenidate was started at 5mg and increased gradually to 30mg (15mg at 8:00AM and 15mg at 12:00 noon), and discontinued before discharge.
Mood measures included the Hamilton Depression Rating Scale (HAM-D) and Zung Self-Rating Depression Scale (ZDS). Cognitive status was evaluated using the Mini-Mental State Exam (MMSE). Motor functioning was assessed using the Fugl-Meyer Scale (FMS) and a modified version of the Functional Independence Measure (M-FIM). All measures were administered pretreatment and weekly thereafter. Side effects were measured after each increase in dosage and weekly.
Patients receiving methylphenidate treatment scored lower on the HAM-D (F(1,18)=5.714, p=.028), lower on the ZDS (F(1,18)=4.206, p=.055), higher on the M-FIM (F(1,18)=5.374, p=.032), and higher on the FMS (F(1,9)=4.060, p=.075) than patients receiving placebo.
Methylphenidate appears to be a safe and effective intervention in early poststroke rehabilitation that may expedite recovery.
确定哌醋甲酯在急性脑卒中康复中的疗效和安全性。
一项前瞻性、随机、双盲、安慰剂对照研究。
连续纳入21名入住社区康复单元的脑卒中患者。
哌醋甲酯（或安慰剂）联合物理治疗，为期3周。哌醋甲酯起始剂量为5mg，逐渐增加至30mg（上午8点15mg，中午12点15mg），出院前停药。
情绪测量指标包括汉密尔顿抑郁量表（HAM-D）和zung自评抑郁量表（ZDS）。使用简易精神状态检查表（MMSE）评估认知状态。使用Fugl-Meyer量表（FMS）和改良版功能独立性测量表（M-FIM）评估运动功能。所有测量均在治疗前及此后每周进行一次。每次增加剂量后及每周测量副作用。
与接受安慰剂治疗的患者相比，接受哌醋甲酯治疗的患者在HAM-D量表上得分更低（F(1,18)=5.714，p=0.028），在ZDS量表上得分更低（F(1,18)=4.206，p=0.055），在M-FIM量表上得分更高（F(1,18)=5.374，p=0.032），在FMS量表上得分更高（F(1,9)=4.060，p=0.075）。
哌醋甲酯似乎是脑卒中后早期康复中一种安全有效的干预措施，可能会加速康复。
