Levodopa Improves Procedural Motor Learning in Chronic Stroke Patients
Abstract
Rösser N, Heuschmann P, Wersching H, Breitenstein C, Knecht S, Flöel A. Levodopa improves procedural motor learning in chronic stroke patients.
Objective
To test the hypothesis that administration of dopamine precursor levodopa improves procedural motor learning (defined as the ability to acquire novel movement patterns gradually through practice) in patients with residual motor deficits in the chronic phase after stroke (≥1y after stroke).
Design
A double-blind, placebo-controlled, randomized crossover design.
Setting
Neurology department in a German university.
Participants
Eighteen patients with chronic motor dysfunction because of stroke (13 men, 5 women; age range, 53–78y; mean time poststroke ± SD, 3.3±2.1y).
Intervention
Patients received 3 doses of levodopa (100mg of levodopa plus 25mg of carbidopa) or placebo before 1 session of procedural motor learning.
Main Outcome Measures
Procedural motor learning performed by using the paretic hand assessed by using a modified version of the serial reaction time task with a probabilistic sequence. The primary outcome measure was the difference in reaction times between random and sequential elements.
Results
Levodopa significantly improved our primary outcome measure, procedural motor learning, compared with placebo (P<.05). Reaction times to random elements, analysis of error rates, psychophysical assessments, and performance in a simple motor task were comparable between conditions, indicating that better learning under levodopa was not caused by differences in response styles, arousal, mood, or motor reaction times but that levodopa modulated learning.
Conclusions
Our results show that levodopa may improve procedural motor learning in patients with chronic stroke, in line with our hypothesis. These findings suggest that this interventional strategy in combination with customary rehabilitative treatments could significantly improve the outcome of neurorehabilitation in the chronic stage after stroke. (Clinicaltrials.gov identifier NCT00126087.)
aDepartment of Neurology, University of Münster, Münster, Germany
bInstitute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
cIMF Münster, University of Münster, Münster, Germany
Reprint requests to Agnes Flöel, MD, Dept of Neurology, University of Münster, Albert-Schweitzer-Str 33, 48149 Münster, Germany
Supported by the Deutsche Forschungsgemeinschaft (grant no. FL 379-4/1), the Bundesministerium für Forschung und Bildung (grant no. 01GW0520), the Innovative Medizinische Forschung Münster (grant nos. FL110605, KN520301), and the Volkswagen Stiftung (grant no. Az I/80 708).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
ABSTRACT