D-Amphetamine for enhancing stroke recovery 安非他命加強中風後的復健?

安非他命加強中風後的復健有效嗎?
Dextroamphetamine, or D-amphetamine, is classified as a psychostimulant drug that promotes increased alertness and focus, as well as decreased fatigue.  It is commonly used in the treatment of narcolepsy and ADHD (it is the primary component of the medicine Adderall).  It’s effects on the cardiovascular system (potential problems with increased blood pressure and heart rate) are a concern when considering it’s use after a stroke.
Several studies have shown d-ampheatmine to enhance neuronal sprouting and stroke recovery in rats and monkeys:
HOWEVER, the mechanisms are not well understood, and the studies on human populations haven’t been so promising.
作用機制了解不多,研究結果還不夠令人信服。

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Cochrane Database Review in 2007 identified 10 small randomized trials of amphetamines in patients with stroke. They concluded that there is not enough evidence to support the routine use of amphetamines to promote recovery after stroke. Further controlled trials are needed.

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Clinical Rehabilitation published a small study in 2003 that failed to show any effect of D-amphetamine on stroke recovery compared with the control group.

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In 2001, Cerebrovascualar Disease published a study that compared traditional rehab to rehab combined with administration of d-amphetamine.  They found that ”all patients improved significantly over the intervention period. Amphetamine-treated patients did not show any increase in motor function or ADL as compared to the control group.”

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Restorative Neurology and Neuroscience published a study in 2005 on the effects of d-amphetamine on arm recovery.  They concluded that “d-Amphetamine failed to facilitate motor performance during training sessions, to promote skill acquisition with training tasks, and most importantly to enhance motor recovery among patients with mild arm paresis after stroke.”

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Cerebrovascular Disease in 2003 published a study concluding that “an increased intensity of physiotherapy in combination with dexamphetamine during the first week after stroke onset did not affect short- or long-term outcome in this limited sample of patients with severe stroke.”  This study lasted only 5 days, and involved subjects with severe weakness and impaired consciousness no greater than 5 days after a stroke.

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Stroke published a study in 2006 which concluded that “in stroke patients with a severe motor deficit, 10 mg AMPH coupled with physiotherapy twice per week for 5 weeks in the early poststroke period provided no additional benefit in motor or functional recovery compared with physiotherapy alone.”

六份論文

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So why do studies on rats show that it works, while studies on humans generally don’t?

Here’s a really in-depth article on the potential reasons that the results of animal studies on d-amphetamines haven’t been found in human studies.  Published in Neurorehabilitation in 2009.

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There IS some research showing that d-amphetamine could enhance speech recovery after a stroke:

有兩份論文指出 

d-amphetamine 可以幫助語言恢復

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International Journal of Neuropsychopharmacology in 2007 published a study which found that, “compared to placebo, Dex enhanced both the rate of learning and the retention of words 1 wk and 1 month later.”  They concluded that d-amphetamine seemed to promote improved short-term memory related to speech.

Neuropsychopharmacology in 2004, published a study that attempted to determine if the beneficial effects that some studies have found in D-amphetamine’s use to improve language re-learning after stroke are related to the drug’s arousing action on the cardiovascular system (increased heart rate, blood pressure, etc), or due to other mechanism’s of true neuroplasticity enhancement.  They concluded “that AMPH’s plasticity-enhancing effect in humans is not related to its cardiovascular arousal. This suggests that the beneficial effects in stroke patients could also be obtained by less cardiovascular active drugs.  Most stroke patients are excluded from treatment with this drug because of a significant risk of cardiovascular dysregulation.”

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Bottom-Line:

Until more research is published, I’m going to side with the cochrane review of 10 high-quality  studies.  The evidence is mixed, and there doesn’t seem to be enough potential benefit to outweigh the possible cardiovascular risks associated with d-amphetamines (effects on blood pressure and heart rate).  However, I encourage you to discuss this with your doctor, especially if recovery of speech is one of the goals you are working toward (because there is some research supporting it’s use for improving language re-learning after a stroke).

Cochrane Database Syst Rev. 2007 Jan 24;(1):CD002090.

Amphetamines for improving recovery after stroke.

AUTHORS’ CONCLUSIONS:

At present, too few patients have been studied to draw any definite conclusions about the effects of amphetamine treatment on recovery from stroke. The suggested benefits on motor function and the non-significant trend towards increased risk of death could be related to imbalances in prognostic variables or other bias in the studies. Further research is therefore justified.

整理了10篇高品質論文
太少的病人,所以對於使用安非他命用在腦中風復健的治療
沒有得出任何確定的結論
好處(運動的進步)並沒有比增加心血管危害(安非他命會導致血壓和心跳的不穩)來的大。
無論如何
如果語言的進步是你現階段最重要的目標
(因為研究顯示語言的重新學習有幫助)
我會鼓勵你去跟你的醫師問看看

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