Advances in Stroke

Developments in this area are now moving faster than ever before. It is evident that recovery drugs and techniques promoting recovery after brain ischemia deserve separate consideration and special efforts. A large number of trials are ongoing, and several new methods are being tested in single or combination mode. We have decided to report Cochrane data, meta-analyses, or (when both not available) to select 1 or 2 major papers representative for each area to illustrate the achieved results and to point to the many promising experimental, clinical, and field trials currently underway.Several drugs have been tested for efficacy in motor recovery in recent years, but none has evolved with such clear significance as is the case for Fluoxetine for Motor Recovery in Acute Ischemic Stroke (FLAME) study.1 This study investigated whether fluoxetine enhances motor recovery if given to patients with motor deficits within the first 10 days after stroke.One hundred eighteen patients with ischemic stroke and hemiplegia or hemiparesis had Fugl-Meyer motor scale (FMMS) scores of ≤55 and were randomly assigned to fluoxetine (n=59; 20 mg once per day, orally) or placebo (n=59) for 3 months starting 5 to 10 days after the onset of stroke. All patients had physiotherapy. The primary outcome measure was the change in the FMMS score between day 0 and day 90 after the start of the study drug. Two patients died before day 90 and 3 withdrew from the study. The remaining 113 showed FMMS improvement at day 90 to be significantly greater in the fluoxetine group (adjusted mean, 34.0 points; 95% confidence interval [CI], 29.7–38.4]) than in the placebo group (24.3 points [19.9–28.7]; P =0.003).The main frequent adverse events in the fluoxetine versus placebo groups were transient and not severe. They included nausea, diarrhea, abdominal pain (14 [25%] versus …