Amphetamine and post-stroke rehabilitation: indications and controversies

There is robust evidence for amphetamine (AMPH) facilitated recovery from behavioral deficits in animal models of stroke. Following experimental lesions, numerous studies of motor, somatosensory and vision recovery show AMPH accelerates the rate of recovery when paired with relevant behavioral experience. While the experimental literature continues to mount for an AMPH effect, the translation to clinical studies has been far less clear. This is due in part to the inherent difficulty of extrapolating results in animals to humans; however, there is much controversy regarding how the basic science data is interpreted for the design of human clinical trials. This review will: overview noteworthy experimental studies that have strong implications for human rehabilitation; describe the blinded drug/placebo clinical trials administering AMPH to enhance recovery of motor and language deficits post-stroke published to date; discuss the various complexities and controversies of designing clinical trials which may affect response/non-response to pharmacologic agents and conclude with suggestions of critical questions still to be answered for the rehabilitation specialist.