Pharmacological support in early motor rehabilitation after acute ischaemic stroke : EAN and ENFS guidelines

Early pharmacological support for post-stroke neurorehabilitation has seen an abundance of mixed results from clinical trials, leaving practitioners at a loss regarding the best options to improve patient outcomes. The objective of this evidence-based guideline is to support clinical decision-making of healthcare professionals involved in the recovery of stroke survivors.

This guideline was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. PubMed, Cochrane Library and Embase were searched (from database inception to June 2018, inclusive) to identify studies on pharmacological interventions for stroke rehabilitation initiated in the first 7 days (inclusive) after stroke, which were delivered together with neurorehabilitation

The recommendations are as follows.

• A weak recommendation against amphetamine for patients in early motor neurorehabilitation is given(Based on low quality of evidence and the observed inferiority for the secondary critical outcome).
• A weak recommendation for cerebrolysin (30 ml, intravenous, minimum 10 days) is given for early motor neurorehabilitation after moderate–severe ischaemic stroke (Based on low and high quality of evidence across primary and secondary critical outcomes.)
• A weak recommendation against citalopram 10 mg is given for early motor neurorehabilitation after acute ischaemic stroke.( Based on low quality of evidence and missing estimates on patients with SAEs.)
• A weak recommendation for citalopram 20 mg is given for early motor neurorehabilitation after acute ischaemic stroke.( Based on moderate quality of evidence for beneficial effects in the critical outcomes)
• A weak recommendation against dextroamphetamine is given for early motor neurorehabilitation after acute ischaemic stroke.( Based on low quality of evidence and no effect on critical outcomes)
• A weak recommendation against DHYZ is given for early motor neurorehabilitation after acute ischaemic stroke.( Based on low-quality evidence for negative effects on the primary critical outcome and moderate quality of evidence for beneficial effects on the secondary critical outcome)
• A weak recommendation against fluoxetine for early motor neurorehabilitation after acute ischaemic stroke was given.
• Based on low-quality evidence for beneficial effects, a weak recommendation against lithium is given for patients in early motor neurorehabilitation.
• Based on low quality of evidence, negligible intervention effect and lack of evidence for the primary critical outcome, a weak recommendation against MLC601 is given for early motor neurorehabilitation in patients after acute ischaemic stroke.
• Based on low-quality evidence, a weak recommendation against PF-03049432 is given for patients in early motor neurorehabilitation.
• No recommendation is made for or against selegiline for neurorehabilitation after acute ischaemic stroke, as this would be speculative given current available evidence.

"Promising advances in basic science also bring new opportunities to study the pharmacological enhancement of post-stroke neurorehabilitation . As new research emerges, this guideline aims to inform clinicians regarding existing pharmacological support in interventions for neurorecovery after acute ischaemic stroke. Updates to this material will potentially elucidate existing conundrums, improve current recommendations, and hopefully expand therapeutic options for stroke survivors."the expert panel concluded.

For full article follow the link: https://doi.org/10.1111/ene.14936

Source : European Journal Of Neurology