Drugs to Enhance Motor Recovery After Stroke.

Abstract

Among the therapeutic strategies under study to improve long-term outcome after stroke are drugs targeting events that underlie recovery. Drugs that enhance recovery are separate from those that promote neuroprotection or reperfusion in patients with stroke. Recovery-based drugs have distinct therapeutic targets that are related to plasticity and growth following stroke, and in general, improvements in behavioral outcome are not accompanied by a reduction in infarct volume. Interventions targeting recovery have a time window measured in days or sometimes weeks-months, suggesting potential utility for a large percentage of patients with stroke. Currently, among drugs that enhance motor recovery after stroke in humans, the strongest evidence exists for serotonergic and dopaminergic agents. Restorative therapies generally target the brain directly, in contrast to approved stroke therapeutics that target arteries, clots, platelets, glucose, or cholesterol. Targeting the brain has wide-ranging implications, for example, in relation to drug delivery. In addition, because restorative drugs aim to change brain structure and function, their effects are influenced by concomitant behavioral experience, a finding that informs selection of entry criteria, outcome measures, and biomarkers in a clinical trial setting. These points underscore the importance of a neural systems approach in studying stroke recovery.