Intervention Review

Amphetamines for improving recovery after stroke

  1. Louise Martinsson1,*,
  2. Hans-Göran Hårdemark2,
  3. Staffan Eksborg3

Editorial Group: Cochrane Stroke Group

Published Online: 24 JAN 2007

Assessed as up-to-date: 8 SEP 2006

DOI: 10.1002/14651858.CD002090.pub2

How to Cite

Martinsson L, Hårdemark HG, Eksborg S. Amphetamines for improving recovery after stroke. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD002090. DOI: 10.1002/14651858.CD002090.pub2.

Author Information

  1. 1

    AstraZeneca, R&D Södertälje, Study Delivery II, Södertälje, Sweden

  2. 2

    University Hospital, Department of Neurology, Uppsala, Sweden

  3. 3

    Karolinska Institute, Department of Woman and Child Health, Karolinska Pharmacy and Childhood Cancer Research Unit, Stockholm, Sweden

*Louise Martinsson, R&D Södertälje, Study Delivery II, AstraZeneca, Södertälje, SE-151 85, Sweden. louise.martinsson@astrazeneca.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 24 JAN 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Animal research shows that treatment with amphetamines improves recovery after focal cerebral ischaemia. If the effects are similar in humans, amphetamine treatment could have a major impact on recovery from stroke.

Objectives

To assess the effects of amphetamine treatment in patients with stroke.

Search methods

We searched the Cochrane Stroke Group Trials Register (last searched January 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2006), MEDLINE (1966 to January 2006), EMBASE (1980 to January 2006), CINAHL (1982 to January 2006), CINAHL (1982 to January 2006), Science Citation Index (1992 to March 2005) and registers of ongoing trials. We also checked the reference lists of all relevant articles and reviews, and contacted researchers in the field.

Selection criteria

Randomized unconfounded trials comparing amphetamine with placebo.

Data collection and analysis

Two review authors independently selected trials for inclusion and assessed trial quality; one extracted the data.

Main results

Ten studies involving 287 patients were included, but not all trials contributed data to each outcome examined in this review. The quality of the trials varied but was generally high. Based on three trials (106 patients) there was no evidence that amphetamine treatment reduced death or dependence (Peto's odds ratio (Peto OR) 1.5, 95% confidence interval (CI) 0.6 to 3.3). Imbalances at baseline with more serious stroke allocated to amphetamine may account for the trend for more deaths at the end of follow up among amphetamine-allocated patients (Peto OR 2.8, 95% CI 0.9 to 8.6). Based on two trials (73 patients) systolic (weighted mean difference (WMD) 8.4 mm Hg, 95% CI 1.6 to 15.2) and diastolic (WMD 4.9 mm Hg, 95% CI 1.1 to 8.8) blood pressure, as well as heart rate, increased (WMD 10.6 bpm, 95% CI 3.3 to 17.8) in amphetamine-allocated patients. Based on six studies (176 patients) there was evidence of a better relative change from baseline to last follow up in motor function (WMD -6.1 points; 95% CI -10.4 to -1.9) Different results with different analysis approaches emphasize caution in the interpretation of the results.

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Amphetamines for improving recovery after stroke

A stroke interrupts the blood flow to the brain, often leading to damage to some functions of the brain. This can cause persisting paralysis of some parts of the body or other difficulties with various physical functions. Experiments in animals have shown that amphetamines (stimulants) might be able to improve recovery from stroke. The mechanisms behind the faster recovery seen after stroke in animals are not clearly understood. This review identified 10 small randomized trials of amphetamines in patients with stroke. There was no evidence that amphetamines did more good than harm. There is not enough evidence to support the routine use of amphetamines to promote recovery after stroke. Further controlled trials are needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

Amphetamines用以改善中風後的復原狀況

動物研究顯示使用amphetamine治療可以改善局部腦缺血後的復原狀況。如果在人身上有類似的效果,amphetamine治療或可以對中風的復原有重大的影響。

目標

評估Amphetamines治療用於中風病人的效果。

搜尋策略

我們搜尋Cochrane Stroke Group Trials Register(搜尋至2006年1月),Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006),MEDLINE (1966年至2006年1月),EMBASE (1980年至2006年1月), CINAHL (1982年至2006年1月), CINAHL (1982年至2006年1月),Science Citation Index (1992年至2005年3月)以及進行中的試驗登錄。我們也核對相關論文與回顧的參考索引,並聯絡此領域的研究者。

選擇標準

比較amphetamine與安慰劑的隨機無干擾試驗(randomized unconfounded trial)。

資料收集與分析

兩位檢閱者各自選擇納入的試驗並評估試驗品質;其中一位篩選資料。

主要結論

有10個試驗囊括287位病人被納入,但並非所有試驗都為此回顧所檢視的每一個預後項目提供資料。試驗的品質不一,但一般來說是高的。根據其中3個試驗(106位病人),並沒有amphetamine治療降低死亡或依賴率(Peto勝算比(Peto OR) 1.5, 95% 信賴區間 (CI) 0.6 至 3.3)的證據。基本條件的不均等,即較嚴重的中風被分派到amphetamine組,或可解釋分配到amphetamine組的病人在追蹤期末有較高死亡率的趨勢(Peto OR 2.8, 95% CI 0.9 to 8.6)。根據其中2個試驗(73位病人),收縮壓(加權平均差weighted mean difference(WMD)8.4 mmHg, 95% CI 1.6 to 15.2),舒張壓(WMD 4.9 mm Hg, 95% CI 1.1 to 8.8),以及心跳速率(WMD 10.6 bpm, 95% CI 3.3 to 17.8)在分配到amphetamine組的病人都有上升。根據其中6個試驗(176位病人),證據顯示從基線到最後一次追蹤的運動功能有較好的相對變化(WMD −6.1 點; 95% CI −10.4 to −1.9)。不同的結果與不同的分析方式使我們應該更為小心地解讀此結果。

作者結論

目前來說,受試的病人數太少,以至於在amphetamine治療對中風復原的效果上無法得到確定的結論。對於運動功能的好處以及非顯著性死亡率上升的趨勢,可能是由於預後變項的不均等或其他偏差所造成。因此更進一步的研究是有必要的。

翻譯人

本摘要由奇美醫院陳軾正翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

Amphetamine用以改善中風後的復原狀況。中風阻斷了到腦部的血流,常會造成腦部某些功能的損害。這可能導致身體的某些部份永久性的癱瘓或是其他種種身理功能上的困難。動物實驗已顯示amphetamine(興奮劑)或許可以改善中風的復原狀況。在動物中風後發現較快速的復原背後,其機轉並未清楚被瞭解。這篇回顧找到了10個研究amphetamine使用在中風病人的小型隨機試驗。並沒有證據顯示使用amphetamine的利多於弊。沒有充足的證據支持例行性使用amphetamine來促進中風後的復原。