Pharmacotherapy in restorative neurology

To evaluate current evidence that recovery after stroke or traumatic brain injury (TBI) can be enhanced by drugs that modulate neurotransmission in the brain.

Small studies performed in chronic stroke patients have indicated that single doses of reboxetine or citalopram improved different aspects of motor functions and that long-lasting application of donepezil reduced aphasic symptoms. Methylphenidate shortened intensive care treatment periods in TBI patients and amantadine improved arousal and cognition. Recent studies in stroke patients did not find beneficial effects of levodopa or dextroamphetamine.

Evidence of drug-related improvement of functions after stroke or TBI is still limited, either because of small and highly selected patient groups or due to conflicting results. Currently, most convincing evidence exists for piracetam for improvement of poststroke aphasia and amantadine for enhancing arousal and cognition after TBI. Some evidence can be found for improvement of stroke-related motor deficits by levodopa, enhanced speed of mental processing in TBI by methylphenidate and improvement of poststroke aphasia by dextroamphetamine. Large randomized controlled trials are needed to evaluate the effectiveness of serotonin reuptake inhibitors or noradrenaline reuptake inhibitors on motor functions.