Post-Stroke Walking Does Not Improve With Added Dopaminergic Therapy
Adding co-careldopa to routine occupational and physical therapy does not improve walking ability after stroke, according to a new study.
To determine whether the dopamine agonist—along with routine occupational and physical therapy—is safe and effective during early rehabilitation after stroke, the researchers conducted the randomized, double-blind study at 51 UK National Health Service (NHS) acute inpatient stroke rehabilitation services.
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Between May 30, 2011, and March 28, 2014, the researchers recruited 1574 participants who had had a new or recurrent clinically diagnosed ischemic or hemorrhagic (excluding subarachnoid hemorrhage) stroke 5 to 42 days before being randomly assigned.
The participants included were unable to walk at least 10 meters, had a score of less than 7 points on the Rivermead Mobility Index, were expected to need rehabilitation, and were able to access rehabilitation after hospitalization.
In all, 308 participants were randomly assigned to receive 6 weeks of oral co-careldopa and 285 participants were randomly assigned to a matched placebo. Participants were assigned to their respective groups, on average, 18 days after stroke onset.
The initial 2 doses of co-careldopa were 62.5 mg (levodopa, 50 mg, and carbidopa, 12.5 mg), and the remaining doses were 125 mg (levodopa, 100 mg, and carbidopa, 25 mg).
In addition to taking the co-careldopa or placebo, the participants also participated in routine NHS physiotherapy and occupational therapy. Participants took a single oral tablet 45 to 60 minutes before their therapy sessions.
The ability to walk independently was defined as achieving a Rivermead Mobility Index score of 7 or more. At week 8, there was no evidence that co-careldopa had improved participants’ ability to walk independently compared with placebo (41% vs 45%).
Vomiting during therapy sessions was the most frequent adverse event and was more common among participants in the co-careldopa group than the placebo group. Serious adverse events and mortality at 12 months were similar between the 2 groups.
“Further research might identify subgroups of patients with stroke who could benefit from dopaminergic therapy at different doses or times after stroke with more intensive motor therapy,” the researchers concluded.
—Colleen Murphy
Reference:
Ford GA, Bhakta BB, Cozens A, et al. Safety and efficacy of co-careldopa as an add-on therapy to occupational and physical therapy in patients after stroke (DARS): a randomised, double-blind, placebo-controlled trial. Lancet. 2019;18(6):P530-538. https://doi.org/10.1016/S1474-4422(19)30147-4.