Evidence mounts for benefits of SSRIs in stroke motor recovery
MedWire News: The selective serotonin-reuptake inhibitor (SSRI) fluoxetine, in conjunction with physiotherapy, boosts the motor recovery of stroke patients, shows the largest randomized trial to date.
The trial, which appears in The Lancet Neurology, included 118 patients who had suffered stroke 5-10 days previously. The patients had Fugl-Meyer motor scale (FMMS) scores of 55 or less, where 0 represents complete hemiplegia and 100 represents normal motor ability.
The final analysis included 113 patients, of whom 57 received fluoxetine 20 mg/day and 56 were given placebo.
"Fluoxetine is a well-tolerated drug that no longer has a patent, and therefore its cost is reasonable," comment François Chollet (Hôpital Purpan, Toulouse, France) and colleagues.
Over the 3-month treatment period, all patient received physiotherapy, using the standard rehabilitation program for their treatment center.
During this time, patients taking fluoxetine achieved an average 34.0-point improvement in FMMS scores, which was significantly greater than the 24.3-point improvement seen in the placebo group. The difference was adjusted to account for baseline differences in age, history of stroke, and FMMS score.
The additional benefits in the fluoxetine group were apparent for upper and for lower limbs.
National Institutes of Health Stroke Scale scores did not significantly differ between the two groups after 3 months. But the proportion of patients who attained functional independence as assessed by the modified Rankin Scale was significantly higher in the fluoxetine than the placebo group.
Also, patients taking fluoxetine were far less likely to develop depression, at 7% versus 29% of the placebo group.
In a related Comment article, Robert Robinson and Harold Adams (University of Iowa, Iowa City, USA) said that some evidence for the effectiveness of SSRIs after stroke has existed for over 10 years, but that the current study is the largest to date.
They stressed the "enormous potential of these findings to change clinical practice," but added that "additional research is needed to test the usefulness of SSRIs in improving outcomes in people with a wide range of neurological impairments after ischemic stroke."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Eleanor McDermid