Potential of Stimulants to Augment Rehabilitation in the Acute Stroke Setting: Preliminary Support

Aims: The objective of these case studies is to explore the possibility of using neurostimulants during the acute stage of stroke to facilitate effective rehabilitation of patients with severe strokes.

Presentation of Cases: In Case 1, methylphenidate was administered to a 63 year old woman with a left anterior cerebral artery infarct who was discharged to inpatient rehabilitation, rather than original recommendation of skilled nursing facility, prior to returning home. In Case 2, modafinil was administered to a 56 year old man with a left middle cerebral artery infarct who was discharged to inpatient rehabilitation prior to returning home. In Case 3, modafinil was administered to a 66 year old man with a left middle cerebral arery infarct who was discharged to inpatient rehabilitation. In Case 4, modafinil and methylphenidate were co-administered to a patient with a hypertensive intracerebral hemorrhage who experienced an adverse event possibly related to neurostimulants resulting in discontinuation. She was discharged to inpatient rehabilitation and subsequently to a skilled nursing facility.

Discussion: All cases initially presented to therapists with barriers to inpatient rehabilitation. Following neurostimulant administration, therapies recommended discharge to inpatient rehabilitation facility due to improvement in initial barriers. Three out of the four cases tolerated the neurostimulant well, while one case required discontinuation due to an adverse event.

Conclusion: Patients with severe strokes are less likely to meet criteria for inpatient rehabilitation. Depressed consciousness and limited attention are major barriers for which neurostimulants may be of benefit in the acute post-stroke setting. Administration of neurostimulants may improve participation in therapy, thus increasing qualification for inpatient rehabilitation, and ultimately accelerate recovery. Safety data in this population during the acute stage of stroke are lacking.