Influence of Drugs on the Recovery of Sensorimotor Function After Stroke

Abstract

ham, NC 27705, U.S.A. Patients who are at risk for cerebrovascular disease and those who have had a recent ischemic stroke are treated with a variety of drugs. Some of these drugs impair recovery of function after experimental focal brain injury in laboratory animals. In order to test the hypothesis that these drugs may also have detrimental effects in man and to determine the feasibility of a prospective study, a retrospective analysis of 58 patients with carotid distribution strokes who were enrolled in a prospective cohort study of stroke outcome were analyzed. Sensorimotor function was measured by observers blind to the study hypothesis shortly after stroke and again 5 and 30 days later with the Fugl-Meyer assessment. Independence in activities of daily living was measured with the Barthel Index. Patients were subsequently divided into two groups based on the drugs received either immediately before the onset of neurologic symptoms or during the subsequent hospitalization. Patients receiving phenytoin, benzodiazepines (triazolam, chlodiazepoxide, or alprazolam), neuroleptics (chlorpromazine,prochlorperazine,orhaloperidol), or the antihypertensive drugs, clonidine or prazosin, constituted the "detrimental drug" group (n = 24). Patients receiving other medications formed the "neutral drug" group (n = 34). The two groups of patients were similar with respect to stroke risk factors, prognostic factors, and initial functional deficits. Compared to patients in the "neutral drug" group, patients in the "detrimental drug" group had poorer sensorimotor function (Mann-Whitney U = 157, Z =-2.04; p = 0.04) and were less independent in activities of daily living (Mann-Whitney U = 139, Z =-2.368; p = 0.02) 30 days after the stroke. "Detrimental drug" group patients also had slower overall 30-day recoveries (Mann-Whitney U = 154, Z =-2.89; p = 0.004). A secondary multivariate analysis indicated that the calculated recovery rate was significantly related to the patient's initial level of consciousness, initial Fugl-Meyer score, study drug group, and race (i.e., the overall 30-day recovery was significantly related to study drug group independent of the severity of the initial deficit). These data are consistent with the hypothesis that specific drugs taken by patients with cerebral infarction may influence their subsequent functional recoveries. Until the emerging pharmacology of functional recovery is better understood, care should be taken in the selection of drugs used in the treatment of patients with cerebrovascular disease.