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Parkinson's Drug Helps Stroke Victims

Early testing of levodopa shows promise for physical therapy

THURSDAY, Sept. 6, 2001 (HealthDayNews) -- Levodopa, a drug used to treat Parkinson's disease, appears to improve the results of physical therapy for stroke patients, German neurologists report.

Results of a small study of just 53 patients are encouraging enough that a multicenter European trial is being planned, says Dr. Friedemann Muller, a neurologist at Bad Aibling Neurological Hospital and lead author of a paper reporting the results in the Sept. 8 issue of The Lancet.

In the study, stroke patients who received daily doses of levodopa -- also known as L-dopa -- during the first three weeks of physical therapy had significantly better scores on a standard test of physical function than those who got a placebo, an inactive ingredient.

"We were surprised that the results were statistically significant for a small number of patients," Muller says. "There have been anecdotal reports that levodopa can improve motor learning after a stroke, but no study up to now has shown it in a scientific fashion."

The L-dopa effect appears to be different in stroke patients than in those with Parkinson's disease, Muller says. In the body, the drug is metabolized first to dopamine and then to norepinephrine, molecules involved in nerve activity. Parkinson's patients benefit from dopamine, while stroke patients probably benefit from the stimulating effect of norepinephrine, Muller says.

The planned trial will test different dosing schedules of levodopa, he says. Even before that testing begins, "some of my colleagues are already using it on a daily basis" because they believe levodopa is a very safe drug, he says.

Dr. Edgar J. Kenton, chairman of the American Stroke Association's advisory committee and professor of clinical neurology at Thomas Jefferson University in Philadelphia, says the beneficial effects of levodopa can be explained by its activity as a stimulant.

"We've known that physical therapy helps stroke patients," Kenton says. "If you can improve their awareness and motivation, those patients do better. Prior studies have shown that if you use stimulants, such as amphetamines, you increase the ability of patients to participate in a physical therapy program."

In the past, some neurologists have used another stimulant drug, Ritalin, as part of a stroke treatment program, Kenton says, and "it is a small move from Ritalin to levodopa."

But because the German trial was small, some questions still have to be answered, he says. For example, most of the patients in the trial had strokes that affected the right side of the brain, which tend to be less severe. A larger study is needed to determine whether left-brain stroke patients will have the same benefits, and exactly what those benefits are, Kenton says.

Still, the levodopa study has implications beyond the treatment of stroke, Muller says.

"There is no reason to believe it will not help other neurological patients," he says. "It might also help brain-damaged trauma patients."

What To Do

A cautious attitude about a small study of a new therapy is advisable until larger trials give a better picture of benefits and possible risks.

Information about brain attacks and recovering from them is available from the American Stroke Association and the National Institute of Neurological Disorders and Stroke.

Or, to learn more about L-dopa, visit the National Parkinson Foundation online.

SOURCES: Interviews with Friedemann Muller, M.D., neurologist, Bad Aibling Neurological Hospital, Bad Aibling, Germany; and Edgar J. Kenton, professor of clinical neurology, Thomas Jefferson University, Philadelphia; Sept. 8, 2001 The Lancet
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