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Methylphenidate modulates cerebral post-stroke reorganization
Jean Tardy1, Jérémie Pariente, Anne Leger
1INSERM U455, Pavillon Riser, Purpan Hospital, Toulouse, France. tardyjean@yahoo.fr
Objective:
We hypothesized that a single dose of methylphenidate (MP) would modulate cerebral motor activation and behavior in patients having suffered a subcortical stroke.
Methods:
Eight men with a single stroke on the corticospinal tract resulting in a pure motor hemiparesia were included in a randomized, cross-over, double-blind, placebo-controlled study. Patients were first evaluated 17 days after stroke onset by validated neurological scales, motor tests and fMRI (flexion/extension of the digits) after 20 mg MP or placebo. Seven days later, the patients underwent the same protocol and received the drug they had not taken at the first evaluation. Each patient was his own control.
Results:
Placebo intake did not change performance. MP compared to placebo elicited a significant improvement in motor performance of the affected hand at the finger tapping test. MP induced: (1) a hyperactivation of the ipsilesional primary sensorimotor cortex including the motor hand and face areas and of the contralesional premotor cortex; (2) a hypoactivation of the ipsilesional anterior cingulum. Hyperactivation in the face motor area correlated positively with the improvement in performance.
Conclusion:
We demonstrated that the reorganized network may efficiently be targeted by the drug and that the effect of MP might partly rely on an improvement in attention/effort through cingulum modulation.
Insights
Methylphenidate (MP) improved motor function in stroke patients by enhancing brain activation in motor areas. This suggests MP may aid recovery by modulating attention and effort networks post-stroke.
Area of Science:
- Neuroscience
- Neurology
- Rehabilitation Medicine
Background:
- Subcortical stroke can impair motor function due to damage to the corticospinal tract.
- Understanding how to modulate brain activity and behavior after stroke is crucial for developing effective rehabilitation strategies.
Purpose of the Study:
- To investigate the effects of a single dose of methylphenidate (MP) on cerebral motor activation and behavioral outcomes in patients with subcortical stroke.
- To test the hypothesis that MP can modulate motor network function and improve motor performance in affected limbs.
Main Methods:
- A randomized, cross-over, double-blind, placebo-controlled study involving eight male patients with pure motor hemiparesis post-stroke.
- Functional magnetic resonance imaging (fMRI) and validated motor tests (including finger tapping) were used to assess brain activity and motor performance.
- Patients were evaluated twice, receiving either 20 mg MP or placebo in a counterbalanced order, with each patient serving as their own control.
Main Results:
- Methylphenidate (MP) significantly improved motor performance in the affected hand compared to placebo, as measured by the finger tapping test.
- MP induced hyperactivation in the ipsilesional primary sensorimotor cortex (including hand and face areas) and contralesional premotor cortex.
- MP also led to hypoactivation in the ipsilesional anterior cingulum, with face area hyperactivation correlating positively with performance improvement.
Conclusions:
- The findings demonstrate that methylphenidate can effectively target the reorganized neural network in stroke patients.
- The therapeutic effect of MP may be partly attributed to enhanced attention and effort, potentially mediated by modulation of the cingulum.
- MP shows potential as an adjunct therapy to improve motor function and facilitate neurorehabilitation after subcortical stroke.
