Levodopa Added to Stroke Rehabilitation: The ESTREL Randomized Clinical Trial

Area of Science:

• Neuroscience
• Clinical Neurology
• Rehabilitation Medicine

Background:

• Levodopa enhances dopaminergic signaling and may promote neuroplasticity, suggesting potential benefits for motor recovery post-stroke.
• Current use of levodopa in stroke rehabilitation is based on mixed evidence regarding its efficacy.

Purpose of the Study:

• To evaluate if levodopa, when added to standardized rehabilitation, improves motor recovery in acute stroke patients compared to placebo.
• The study aimed to provide definitive evidence on levodopa's role in post-stroke motor rehabilitation.

Main Methods:

• A double-blind, placebo-controlled randomized clinical trial involving 610 patients with acute stroke and hemiparesis.
• Participants received either levodopa/carbidopa or placebo three times daily for 39 days, alongside active task-oriented training.
• The primary outcome measure was the change in Fugl-Meyer Assessment (FMA) total score at 3 months.

Main Results:

• No significant difference in motor function (FMA score) was observed between the levodopa and placebo groups at 3 months (mean difference -0.90 points; P=.54).
• The median FMA score was 68 in the levodopa group versus 64 in the placebo group.
• Serious adverse events were comparable between groups, with infection being the most common.

Conclusions:

• Levodopa, when administered with standardized rehabilitation, did not significantly enhance motor function recovery in patients with acute stroke.
• The findings do not support the routine use of levodopa as an adjunct therapy for improving motor outcomes after stroke.