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Meta-Analysis
. 2007 Jan 24;2007(1):CD002090.
doi: 10.1002/14651858.CD002090.pub2.

Amphetamines for improving recovery after stroke

L Martinsson  1 , H Hårdemark, S Eksborg
Affiliations
Meta-Analysis

Amphetamines for improving recovery after stroke

L Martinsson et al. Cochrane Database Syst Rev. .

Abstract

Background: Animal research shows that treatment with amphetamines improves recovery after focal cerebral ischaemia. If the effects are similar in humans, amphetamine treatment could have a major impact on recovery from stroke.

Objectives: To assess the effects of amphetamine treatment in patients with stroke.

Search strategy: We searched the Cochrane Stroke Group Trials Register (last searched January 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE (1966 to January 2006), EMBASE (1980 to January 2006), CINAHL (1982 to January 2006), CINAHL (1982 to January 2006), Science Citation Index (1992 to March 2005) and registers of ongoing trials. We also checked the reference lists of all relevant articles and reviews, and contacted researchers in the field.

Selection criteria: Randomized unconfounded trials comparing amphetamine with placebo.

Data collection and analysis: Two review authors independently selected trials for inclusion and assessed trial quality; one extracted the data.

Main results: Ten studies involving 287 patients were included, but not all trials contributed data to each outcome examined in this review. The quality of the trials varied but was generally high. Based on three trials (106 patients) there was no evidence that amphetamine treatment reduced death or dependence (Peto's odds ratio (Peto OR) 1.5, 95% confidence interval (CI) 0.6 to 3.3). Imbalances at baseline with more serious stroke allocated to amphetamine may account for the trend for more deaths at the end of follow up among amphetamine-allocated patients (Peto OR 2.8, 95% CI 0.9 to 8.6). Based on two trials (73 patients) systolic (weighted mean difference (WMD) 8.4 mm Hg, 95% CI 1.6 to 15.2) and diastolic (WMD 4.9 mm Hg, 95% CI 1.1 to 8.8) blood pressure, as well as heart rate, increased (WMD 10.6 bpm, 95% CI 3.3 to 17.8) in amphetamine-allocated patients. Based on six studies (176 patients) there was evidence of a better relative change from baseline to last follow up in motor function (WMD -6.1 points; 95% CI -10.4 to -1.9) Different results with different analysis approaches emphasize caution in the interpretation of the results.

Authors' conclusions: At present, too few patients have been studied to draw any definite conclusions about the effects of amphetamine treatment on recovery from stroke. The suggested benefits on motor function and the non-significant trend towards increased risk of death could be related to imbalances in prognostic variables or other bias in the studies. Further research is therefore justified.

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Conflict of interest statement

Dr Louise Martinsson and Prof Nils Gunnar Wahlgren (co‐author of the first version of the review) have been involved in one trial included in the review (Martinsson 2003). Dr Hans‐Göran Hårdemark was chairman of the safety committee in the same study.

Figures

1.1
1.1. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 1 Dead or dependent at final follow up.
1.2
1.2. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 2 Death from all causes at final follow up.
1.3
1.3. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 3 Death from all causes after end of treatment.
1.4
1.4. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 4 Systolic blood pressure during treatment.
1.5
1.5. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 5 Change in systolic blood pressure during treatment.
1.6
1.6. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 6 Diastolic blood pressure during treatment.
1.7
1.7. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 7 Change in diastolic blood pressure during treatment.
1.8
1.8. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 8 Heart rate during treatment.
1.9
1.9. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 9 Change in heart rate during treatment.
1.10
1.10. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 10 Motor function at final follow up.
1.11
1.11. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 11 Relative change in motor function until final follow up.
1.12
1.12. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 12 Time to complete motor task.
1.13
1.13. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 13 Time to walk 10 metres.
1.14
1.14. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 14 Activities of daily living at final follow up.
1.15
1.15. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 15 Relative change in activities of daily living until final follow up.
1.16
1.16. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 16 Neurological function at final follow up.
1.17
1.17. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 17 Relative change in neurological function until final follow up.
1.18
1.18. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 18 Language function at final follow up.
1.19
1.19. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 19 Change in language function until final follow up.
1.20
1.20. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 20 Depression at final follow up.
1.21
1.21. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 21 Intention‐to‐treat analysis of motor function at final follow up.
1.22
1.22. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 22 Intention‐to‐treat analysis of relative change in motor function until final follow up.
1.23
1.23. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 23 Intention‐to‐treat analysis of activities of daily living at final follow up.
1.24
1.24. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 24 Intention‐to‐treat analysis of relative change in activities of daily living until final follow up.
1.25
1.25. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 25 Intention‐to‐treat analysis of neurological function at final follow up.
1.26
1.26. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 26 Intention‐to‐treat analysis of relative change in neurological function until final follow up.
1.27
1.27. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 27 Intention‐to‐treat analysis of language function at follow up.
1.28
1.28. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 28 Intention‐to‐treat analysis of relative change in language function until follow up.
1.29
1.29. Analysis
Comparison 1 Amphetamine versus placebo for stroke, Outcome 29 Intention‐to‐treat analysis of depression at final follow up (same as Depression at final follow up).
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Update of

References

References to studies included in this review

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MeSH terms