Methylphenidate in Post-Stroke Rehabilitation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cerebrovascular disease carries significant morbidity and mortality worldwide. Medical practice has come a long way in optimizing risk factors, managing acute stroke, and preventing recurrence. There are a multitude of complications, ranging from spasticity and neuropathic pain to behavioural changes. The post-stroke period typically consists of medical management of symptoms and physical rehabilitation to recover motor function. Many patients also require occupational therapy and holistic support. Therefore, patients who have suffered a stroke require a multi-disciplinary approach to management; this is often lengthy and resource-intensive. There has been much research into interventions aimed at reducing patient morbidity and improving their quality of life. A systematic review of randomized controlled trials and a meta-analysis of results were carried out to assess the effects of methylphenidate, a dopamine and noradrenaline reuptake inhibitor, on post-stroke rehabilitation, keeping in consideration functional outcome measures and effect on mood. Limitations encountered include the quality of studies, small sample sizes, differences in treatment protocol, and varied outcome measures. There is some evidence to suggest methylphenidate may have a positive effect on mood, but there were no significant results to support its use in functional recovery. There is a need for larger trials with more sensitive and standardized outcome measures.