Skip to main content
Article thumbnail
Location of Repository

Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333)

By Nikola Sprigg, Mark Willmot, Laura J. Gray, Alan Sunderland, Val Pomeroy, Marion Walker and Philip M.W. Bath

Abstract

Amphetamine enhances recovery after experimental ischaemia and has shown promise in small clinical trials when combined with motor or sensory stimulation. Amphetamine, a sympathomimetic, might have haemodynamic effects in stroke patients, although limited data have been published. Subjects were recruited 3-30 days post ischaemic stroke into a phase II randomised (1:1), double blind, placebo-controlled trial. Subjects received dexamphetamine (5mg initially, then 10mg for 10 subsequent doses with 3 or 4 day separations) or placebo in addition to inpatient physiotherapy. Recovery was assessed by motor scales (Fugl-Meyer, FM), and functional scales (Barthel index, BI and modified Rankin score, mRS). Peripheral blood pressure (BP), central haemodynamics and middle cerebral artery blood flow velocity were assessed before, and 90 minutes after, the first 2 doses. 33 subjects were recruited, age 33-88 (mean 71) years, males 52%, 4-30 (median 15) days post stroke to inclusion. 16 patients were randomised to placebo and 17 amphetamine. Amphetamine did not improve motor function at 90 days; mean (standard deviation) FM 37.6 (27.6) vs. control 35.2 (27.8) (p=0.81). Functional outcome (BI, mRS) did not differ between treatment groups. Peripheral and central systolic BP, and heart rate, were 11.2 mmHg (p=0.03), 9.5 mmHg (p=0.04) and 7 beats/minute (p=0.02) higher respectively with amphetamine, compared with control. A non-significant reduction in myocardial perfusion (Buckberg Index) was seen with amphetamine. Other cardiac and cerebral haemodynamics were unaffected. Amphetamine did not improve motor impairment or function after ischaemic stroke but did significantly increase BP and heart rate without altering cerebral haemodynamics

Publisher: Nature Publishing Group
Year: 2007
OAI identifier: oai:eprints.nottingham.ac.uk:535
Provided by: Nottingham ePrints

Suggested articles

Citations

  1. A double-blind placebo-controlled study of the effects of amphetamine and physiotherapy after stroke. Cerebrovasc Dis.
  2. A double-blind placebo-controlled study of the use of amphetamine in the treatment of aphasia.
  3. A single injection of D-amphetamine facilitates improvements in motor training following a focal cortical infarct in squirrel monkeys. Neurorehabil Neural Repair. doi
  4. Acute stroke therapy trials: problems in patient accrual.
  5. Amphetamine failed to improve motor function in acute stroke (Abstract).
  6. Amphetamine fails to facilitate motor performance and to enhance motor recovery among stroke patients with mild arm paresis: Interim analysis and termination of a double blind, randomised, placebo-controlled trial. Restorative Neurology and Neuroscience.
  7. (1339). Amphetamine paired with physical therapy accelerates motor recovery after stroke.
  8. Amphetamine promotes recovery from sensory-motor integration deficit after thrombotic infarction of the primary somatosensory rat cortex. doi
  9. Amphetamine with experience promotes recovery of locomotor function after unilateral frontal cortex injury in the cat. Brain Res.
  10. (2003). Amphetamines for improving recovery after stroke (Cochrane Review). The Cochrane Library.
  11. An updated clinical primer on large artery mechanics: implications of pulse waveform analysis and arterial tonometry. Current Opinion in Cardiology.
  12. and experience interact to affect rate of recovery after motor cortex injury. doi
  13. Brain Plasticity and stroke rehabilitation; the Willis Lecture. doi
  14. Catecholaminergic Consolidation of Motor Cortex Neuroplasticity in Humans. Cerebral Cortex.
  15. Classification and natural history of clinically identifiable subtypes of cerebral infarction.
  16. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial.
  17. Collaboration. Age specific relevance of usual blood pressure to vascular mortality: a meta analysis of individual data for one million adults in 61 prospective studies.
  18. (2001). Comparison of physical therapy and physical therapy with amphetamines in sensorimotor recovery of acute stroke patients: randomised control. J Neurol Sci.
  19. Damphetamine does not improve outcome of somatosensory training.
  20. Dipyridamole for preventing recurrent ischemic stroke and other vascular events: a metaanalysis of individual patient data from randomized controlled trials.
  21. Doppler estimation of zero flow pressure during changes in downstream pressure in a bench model of a circulation using pulsatile flow.
  22. Effect of dextroamphetamine on motor recovery after stroke.
  23. Effects of amphetamine and/or l-dopa and physiotherapy after stroke - a blinded randomized study. Acta Neurol Scand.
  24. Effects of inhaled nitrous oxide 50% on estimated cerebral perfusion pressure and zero flow pressure in healthy volunteers.
  25. Enhanced neocortical neural sprouting, synaptogenesis, and behavioral recovery with D-amphetamine therapy after neocortical infarction in rats.
  26. Enhancing recovery after stroke with noradrenergic pharmacotherapy: a new frontier?
  27. Evidence that amphetamine with physical therapy promotes recovery of motor function in stroke patients.
  28. Intracerebral haemorrhage in young adults: the emerging importance of drug misuse.
  29. Methamphetamine Potentiates Ischemia/Reperfusion Insults after Transient Middle Cerebral Artery Ligation.
  30. Methylphenidate in early poststroke recovery: a doubleblind, placebo-controlled study.
  31. Modifications of Practice-dependent Plasticity in Human Motor Cortex by Neuromodulators. Cerebral Cortex.
  32. Modulation of Use-Dependent Plasticity by D-Amphetamine. Annals of Neurology.
  33. Motor impairment and recovery in the upper limb after stroke: Behavioural and Neuroanatomical correlates.
  34. Motor response to amphetamine treatment, task-specific training, and limited motor experience in a postacute animal stroke model. Experimental Neurology.
  35. No benefit from D-amphetamine when added to physiotherapy after stroke: a randomised placebo-controlled study. Clinical Rehabilitation.
  36. Pharmacological enhancement of recovery from stroke. Current Medical Literature: Stroke Review.
  37. Pharmacological Modulation of Plasticity in the Human Motor Cortex. Neurorehabilitation and Neural Repair. doi
  38. Physiotherapy coupled with Dextroamphetamine for rehabilitation after hemiparetic stroke.
  39. (1999). Potential effects of common drugs on stroke recovery. Arch Neurol. doi
  40. Regional cerebral blood flow response to oral amphetamine challenge in healthy volunteers.
  41. Rehabilitation Pharmacology: Bridging Laboratory Work to Clinical Application.
  42. Relation of heart rate and systolic blood pressure to the onset of pain in angina pectoris.
  43. Relationship between functional outcome and baseline blood pressure, pulse pressure and heart rate in acute ischaemic stroke: data from the TAIST trial.
  44. Safety of dexamphetamine in acute ischaemic stroke-randomized double-blind controlled dose escalation trial.
  45. Safety of dexamphetamine in acute ischaemic strokerandomized double-blind controlled dose escalation trial.
  46. Stroke Research Priorities for the Next Decade -- A Representative View of the European Scientific Community. CerebrovascDis. doi
  47. Subendocardial ischaemia after cardiopulmonary bypass.
  48. Transcranial doppler for the assessment of intracranial arterial flow velocity - Part 1. Surgical Neurology.

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.