Rotigotine as Pharmacological Augmentation Strategy of Early Rehabilitation of Acute Ischemic Stroke Patient

Abstract

Background Early rehabilitation in stroke patient is generally regarded as key strategy to improve clinical outcome and patients quality of life. Based on theoretical considerations of brain plasticity and experimental studies pharmacological augmentation of stroke rehabilitation might be a reasonable intervention to further improve stroke patient prognosis. We summarize here our experience with rotigotine patches 2mg/24 hours as pharmacological augmentation strategy in early rehabilitation of acute ischemic stroke patient. Methods We limited the observation to a small group of patients with acute ischemic stroke resulting in a severe hempiraresis/hemiplegia (NIHSS score on motor item range 3-4) with premorbid mRankin=0, no previous history of extrapiramidal disorders, and not previously taking Monoamine-Oxidse Inhibitors (MAOIs), dopaminergic or sympathomimetic agents. We excluded patients who received r-TPA treatment. Each patient received 30 minutes of rehabilitation twice a day within 24 hours stroke onset and stroke unit standard care. Treatment with rotigotine patches 2 mg daily was started within 24 hours stroke onset as well. Results: We included 16 patients (12 F 4 4M) mean age 79,1 (ranging from 69 to 91), mean NIHSS score on admittance to the stroke unit was 15,5 (ranging from 6 to 19), with motor items score being 3 or 4, after seven days, global mean NIHSS score was 12 (4 to 19) with more than 50% (11 patients) showing an improvement of motor item score. Conclusions Stroke Unit standard care, early rehabilitation improve patient prognosis; pharmacological augmentation with rotigotine of early rehabilitation may contribute to a better quality of life and functional outcome. Further studies are needed in this field as actual literature is poor on this topic.