Levodopa improbe motor function in chronic stroke by modulating motor cortex excitability. A single-blind placebo-controlled crossover pilot study.

Background and Purpose: Chronic stroke patients experience various degrees of motor disability. New therapeutically intervention with promising results have been emerged in recent years, such the use of drugs to enhance motor recovery. We conducted a single-blind pla- cebo-controlled crossover pilot study to investigate the effects of prolonged treatment with L-DOPA in stroke patients. Materials and Methods: Ten chronic stroke patients were investi- gated. Patients received placebo or L-DOPA 100 mg daily for 5 weeks. Patients’ clinical evaluation and TMS recordings were per- formed before and after 5 weeks of treatment. We tested drug’s effects with different scales, as the Modified Ashworth Scale, the Rivermead Motor Assessment, the Nine Hole Peg Test; the 10 m walking test. Each subject completed the Beck Depression Inventory. TMS parameters recorded from the affected and unaffected hemisphere were resting motor threshold, motor evoked potential amplitude and cortical silent period. Results: After L-DOPA treatment patients improved their walking speed and manual dexterity with the affected hand, with a decreased upper limb hypertonus. There was a lengthening of cortical silent period over the affected hemisphere. Conclusion: In this study we found that a 5 weeks treatment with a single oral dose of levodopa improved some aspects of the motor performance of patients modulating the cortical excitability. The lengthening of CSP after levo-dopa treatment suggests the role of inhibitory mechanisms in motor recovery in stroke patients. Combination of physical rehabilitation with a pharmacological.