Methylphenidate in early poststroke recovery: A double-blind, placebo-controlled study

Objective: To determine the efficacy and safety of methylphenidate in acute stroke rehabilitation. Design: A prospective, randomized, double-blind, placebo-controlled study. Patients and Setting: Twenty-one stroke patients consecutively admitted to a community-based rehabilitation unit. Intervention: Three-week treatment of methylphenidate (or placebo) in conjunction with physical therapy. Methylphenidate was started at 5mg and increased gradually to 30mg (15mg at 8:00AM and 15mg at 12:00 noon), and discontinued before discharge. Main Outcome Measures: Mood measures included the Hamilton Depression Rating Scale (HAM-D) and Zung Self-Rating Depression Scale (ZDS). Cognitive status was evaluated using the Mini-Mental State Exam (MMSE). Motor functioning was assessed using the Fugl-Meyer Scale (FMS) and a modified version of the Functional Independence Measure (M-FIM). All measures were administered pretreatment and weekly thereafter. Side effects were measured after each increase in dosage and weekly. Results: Patients receiving methylphenidate treatment scored lower on the HAM-D (F(1,18) = 5.714, p = .028), lower on the ZDS (F(1,18)= 4.206, p = .055), higher on the M-FIM (F(1,18)= 5.374, p = .032), and higher on the FMS (F(1,9) = 4.060, p = .075) than patients receiving placebo. Conclusion: Methylphenidate appears to be a safe and effective intervention in early poststroke rehabilitation that may expedite recovery. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.