Fluoxetine for Motor Recovery After Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial

Mahfuzur Rahman Babul; Hassanuzzaman; Zaman Ahammed; Anwarul Kibria; Golam Faruk; Akramul Azam; Mizanur Rahman

doi:doi:10.11648/j.ajpn.20170503.11

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Fluoxetine for Motor Recovery After Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial

Mahfuzur Rahman Babul, Hassanuzzaman, Zaman Ahammed, Anwarul Kibria, Golam Faruk, Akramul Azam, Mizanur Rahman

Published in American Journal of Psychiatry and Neuroscience (Volume 5, Issue 3)

Received: 3 April 2017 Accepted: 19 April 2017 Published: 31 May 2017

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Abstract

Hemiplegia and hemiparesis are the most common deficits caused by stroke. A few small clinical trials suggest that Fluoxetine enhances motor recovery but its clinical efficacy is unknown in our setting. A randomized placebo-controlled trial was conducted at Neurology and medicine ward of Chittagong Medical College Hospital from 1/1/2013 to 31/12/2013. One hundred and twenty eight patients, aged between 40-60 years with a diagnosis of acute ischaemic stroke who fulfilled the defined inclusion and exclusion criteria were selected for the study. Eligible patients were randomly assigned, using a simple lottery method, in a 1:1 ratio to Fluoxetine (20 mg once per day, orally) or placebo group for 3 months starting within 10 days after the onset of stroke. The primary outcome was the mean change in the Rivermead Mobility Index (RMI) score between inclusion (day 0) and day 90. RMI score was significantly changed from D 0 to D 90 in Fluoxetine group in comparison to placebo group (p <.001) and mean (±SD) improvement of RMI score in 90 days were significantly greater in the Fluoxetine group, than in the placebo group [7.08 (±3.26) vs. 4.40 (±2.53)]. Patients treated with Fluoxetine were nearly 3.2 times more likely to show motor improvement than placebo group and the NNT was 2. In patients with acute ischaemic stroke and with motor deficit, the early administration of Fluoxetine with physiotherapy enhanced motor recovery after 3 months.

Published in	American Journal of Psychiatry and Neuroscience (Volume 5, Issue 3)
DOI	10.11648/j.ajpn.20170503.11
Page(s)	31-36
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Fluoxetine, Ischaemic Stroke, Rivermead Mobility Index (RMI), NNT: Number Needed to Treat

References

[1]	Frosch MP, Anthony DC, Girolami UD. Central Nervous system. In: Cotran, RS, Kumar V, Fausto N, Nelso F, Robbins SL, Abbas AK(Eds). Robbins and Cotran pathologic basis of disease. 7^th ed. 2005 St. Louis, Mo: Elsevier Saunders; 1325-1419.
[2]	Mukherjee D. and Chirag PG. Epidemiology and the Global Burden of Stroke World Neurosurg, 2011, 76, 6S:S85-S90.
[3]	Rathor SS, Hinn AR, Cooper LS, Tyroler HA, Rosamond WD. Characterization of incident stroke signs and symptoms: findings from the atherosclerosis risk in communities study. Stroke.2002; 33:2718–2721.
[4]	Stewart JC, Cramer SC. Patient-reported measures provide unique insights into motor function after stroke. Stroke. 2013; 44:1111–1116.
[5]	Cools R, Roberts AC, Robbins TW. Serotoninergic regulation of emotional and behavioural control processes. Trends Cogn Sci. 2008; 12:31–40.
[6]	Logue SF, Gould TJ. The neural and genetic basis of executive function: attention, cognitive flexibility, and response inhibition. Pharmacol Biochem Behav. 2011; 123: 45–54.
[7]	Cowen P, Sherwood AC. The role of serotonin in cognitive function: evidence from recent studies and implications for understanding depression. J Psycho pharmacol. 2013; 27:575–583.
[8]	Dam M, Tonin P, De Boni A, Pizzolato G, Casson S, Ermani M, et al. Effects of fluoxetine and maprotiline on functional recovery in poststroke hemiplegic patients undergoing rehabilitation therapy. Stroke. 2006; 27: 1211–1214.
[9]	Miyai I, Reding R. Effects of antidepressants on functional recovery following stroke. J Neuro Rehab.2008; 12:5–13.
[10]	Pariente J, Loubinoux I,Carel C,Albucher JF,Leger A,Manelfe C,et.al. Fluoxetine modulates motor performance and cerebral activation of patients recovering from stroke. Ann Neurol.2001; 50: 718–729.
[11]	Chollet F, Tardy J, Albucher JF, Thalamas C, Berard E, Lamy C, et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. Lancet Neurol.2011; 10: 123–130.
[12]	Walker FR. A critical review of the mechanism of action for the selective serotonin reuptake inhibitors: do these drugs possess anti-inflammatory properties and how relevant is this in the treatment of depression? Neuropharmacology. 2013; 67: 304–317.
[13]	Santarelli L, Saxe M, Gross C, Surget A, Battaglia F, Dulawa S, et. al. Requirement of hippocampal neurogenesis for the behavioral effects of antidepressants. Science. 2003; 301: 805–809. doi: 10.1126/science.1083328.
[14]	GerdelatMas A, Loubinoux I, Tombari D, Rascol O, Chollet F, Simonetta-Moreau M. Chronic administration of selective serotonin reuptake inhibitor (SSRI) paroxetine modulates human motor cortex excitability in healthy subjects. Neuroimage. 2005; 27: 314–322.
[15]	Maya Vetencourt JF, Sale A, Viegi A, Baroncelli L, De Pasquale R, O’Leary OF, et al. The antidepressant fluoxetine restores plasticity in the adult visual cortex. Science. 2008; 320: 385–388.
[16]	Guirado R, Perez-Rando M, Sanchez-Matarredona D,Castrén E, Nacher J. Chronic fluoxetine treatment alters the structure, connectivity and plasticity of cortical interneurons. Int J Neuropsychopharmacol. 2011; 17: 1635–1646.
[17]	AclerM, RobolE, FiaschiA, Manganotti P. A double blind placebo RCT to investigate the effects of serotonergic modulation on brain excitability and motor recovery in stroke patients. J.Neurol 2009; 256, 1152–1158.
[18]	Michelle AC, Richard F, Josa R, Karem W. Pharmacology, Lippincott’s Illustrated Reviews. 5^th ed.2012; p151-153.
[19]	Liepert J. Pharmacotherapy in restorative neurology. Curr Opin Neurol 2008: 183-93.
[20]	Lim CM, Kim SW, Park JY, Kim C, Yoon SH, Lee JK. Fluoxetine affords robust neuroprotection in the postischaemic brain via its anti-inflammatory effect. Neurosci Res 2009.
[21]	Zittel S, Weiller C, Liepert J: Citalopram improves dexterity in chronic stroke patients. Neurorehabil Neural Repair. 2008, 22: 311-314.
[22]	Muir KW, Buchan A, von Kummer R, Rother J, Baron JC. Imaging of acute stroke. Lancet Neurol 2006; 5: 755-768.
[23]	Kayasthagir PK, Hasanuzzaman M, Khondoker MA. l Chronic Helicobacter Pylori Infection as A Risk Factor for Acute Ischaemic Cerebral Stroke,Bang jour of Neuro 2010;10:12-22.
[24]	Mackay J, Mensah G: The Atlas of Heart Disease and Stroke.Geneva, Switzerland, World Health Organization, 2004.
[25]	Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003; 2: 43-53.
[26]	Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003; 2: 43-53.

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APA Style

Mahfuzur Rahman Babul, Hassanuzzaman, Zaman Ahammed, Anwarul Kibria, Golam Faruk, et al. (2017). Fluoxetine for Motor Recovery After Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial. American Journal of Psychiatry and Neuroscience, 5(3), 31-36. https://doi.org/10.11648/j.ajpn.20170503.11

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ACS Style

Mahfuzur Rahman Babul; Hassanuzzaman; Zaman Ahammed; Anwarul Kibria; Golam Faruk, et al. Fluoxetine for Motor Recovery After Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial. Am. J. Psychiatry Neurosci. 2017, 5(3), 31-36. doi: 10.11648/j.ajpn.20170503.11

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AMA Style

Mahfuzur Rahman Babul, Hassanuzzaman, Zaman Ahammed, Anwarul Kibria, Golam Faruk, et al. Fluoxetine for Motor Recovery After Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial. Am J Psychiatry Neurosci. 2017;5(3):31-36. doi: 10.11648/j.ajpn.20170503.11

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@article{10.11648/j.ajpn.20170503.11,
  author = {Mahfuzur Rahman Babul and Hassanuzzaman and Zaman Ahammed and Anwarul Kibria and Golam Faruk and Akramul Azam and Mizanur Rahman},
  title = {Fluoxetine for Motor Recovery After Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial},
  journal = {American Journal of Psychiatry and Neuroscience},
  volume = {5},
  number = {3},
  pages = {31-36},
  doi = {10.11648/j.ajpn.20170503.11},
  url = {https://doi.org/10.11648/j.ajpn.20170503.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajpn.20170503.11},
  abstract = {Hemiplegia and hemiparesis are the most common deficits caused by stroke. A few small clinical trials suggest that Fluoxetine enhances motor recovery but its clinical efficacy is unknown in our setting. A randomized placebo-controlled trial was conducted at Neurology and medicine ward of Chittagong Medical College Hospital from 1/1/2013 to 31/12/2013. One hundred and twenty eight patients, aged between 40-60 years with a diagnosis of acute ischaemic stroke who fulfilled the defined inclusion and exclusion criteria were selected for the study. Eligible patients were randomly assigned, using a simple lottery method, in a 1:1 ratio to Fluoxetine (20 mg once per day, orally) or placebo group for 3 months starting within 10 days after the onset of stroke. The primary outcome was the mean change in the Rivermead Mobility Index (RMI) score between inclusion (day 0) and day 90. RMI score was significantly changed from D 0 to D 90 in Fluoxetine group in comparison to placebo group (p <.001) and mean (±SD) improvement of RMI score in 90 days were significantly greater in the Fluoxetine group, than in the placebo group [7.08 (±3.26) vs. 4.40 (±2.53)]. Patients treated with Fluoxetine were nearly 3.2 times more likely to show motor improvement than placebo group and the NNT was 2. In patients with acute ischaemic stroke and with motor deficit, the early administration of Fluoxetine with physiotherapy enhanced motor recovery after 3 months.},
 year = {2017}
}

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TY  - JOUR
T1  - Fluoxetine for Motor Recovery After Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial
AU  - Mahfuzur Rahman Babul
AU  - Hassanuzzaman
AU  - Zaman Ahammed
AU  - Anwarul Kibria
AU  - Golam Faruk
AU  - Akramul Azam
AU  - Mizanur Rahman
Y1  - 2017/05/31
PY  - 2017
N1  - https://doi.org/10.11648/j.ajpn.20170503.11
DO  - 10.11648/j.ajpn.20170503.11
T2  - American Journal of Psychiatry and Neuroscience
JF  - American Journal of Psychiatry and Neuroscience
JO  - American Journal of Psychiatry and Neuroscience
SP  - 31
EP  - 36
PB  - Science Publishing Group
SN  - 2330-426X
UR  - https://doi.org/10.11648/j.ajpn.20170503.11
AB  - Hemiplegia and hemiparesis are the most common deficits caused by stroke. A few small clinical trials suggest that Fluoxetine enhances motor recovery but its clinical efficacy is unknown in our setting. A randomized placebo-controlled trial was conducted at Neurology and medicine ward of Chittagong Medical College Hospital from 1/1/2013 to 31/12/2013. One hundred and twenty eight patients, aged between 40-60 years with a diagnosis of acute ischaemic stroke who fulfilled the defined inclusion and exclusion criteria were selected for the study. Eligible patients were randomly assigned, using a simple lottery method, in a 1:1 ratio to Fluoxetine (20 mg once per day, orally) or placebo group for 3 months starting within 10 days after the onset of stroke. The primary outcome was the mean change in the Rivermead Mobility Index (RMI) score between inclusion (day 0) and day 90. RMI score was significantly changed from D 0 to D 90 in Fluoxetine group in comparison to placebo group (p <.001) and mean (±SD) improvement of RMI score in 90 days were significantly greater in the Fluoxetine group, than in the placebo group [7.08 (±3.26) vs. 4.40 (±2.53)]. Patients treated with Fluoxetine were nearly 3.2 times more likely to show motor improvement than placebo group and the NNT was 2. In patients with acute ischaemic stroke and with motor deficit, the early administration of Fluoxetine with physiotherapy enhanced motor recovery after 3 months.
VL  - 5
IS  - 3
ER  -

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Author Information

Mahfuzur Rahman Babul

Medical Assistant Training School, Noakhali, Bangladesh
Hassanuzzaman

Department of Neurology, Chittagong Medical College Hospital, Chittagong, Bangladesh
Zaman Ahammed

Department of Neurology, Chittagong Medical College Hospital, Chittagong, Bangladesh
Anwarul Kibria

Department of Anatomy, Chittagong Medical College, Chittagong, Bangladesh
Golam Faruk

Department of Anatomy, Chittagong Medical College, Chittagong, Bangladesh
Akramul Azam

Department of Pharmacology, Rangamati Medical College, Chittagong, Bangladesh
Mizanur Rahman

Department of Biochemistry, Rangamati Medical College, Chittagong, Bangladesh

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APA Style

Mahfuzur Rahman Babul, Hassanuzzaman, Zaman Ahammed, Anwarul Kibria, Golam Faruk, et al. (2017). Fluoxetine for Motor Recovery After Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial. American Journal of Psychiatry and Neuroscience, 5(3), 31-36. https://doi.org/10.11648/j.ajpn.20170503.11

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ACS Style

Mahfuzur Rahman Babul; Hassanuzzaman; Zaman Ahammed; Anwarul Kibria; Golam Faruk, et al. Fluoxetine for Motor Recovery After Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial. Am. J. Psychiatry Neurosci. 2017, 5(3), 31-36. doi: 10.11648/j.ajpn.20170503.11

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AMA Style

Mahfuzur Rahman Babul, Hassanuzzaman, Zaman Ahammed, Anwarul Kibria, Golam Faruk, et al. Fluoxetine for Motor Recovery After Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial. Am J Psychiatry Neurosci. 2017;5(3):31-36. doi: 10.11648/j.ajpn.20170503.11

Copy | Download

@article{10.11648/j.ajpn.20170503.11,
  author = {Mahfuzur Rahman Babul and Hassanuzzaman and Zaman Ahammed and Anwarul Kibria and Golam Faruk and Akramul Azam and Mizanur Rahman},
  title = {Fluoxetine for Motor Recovery After Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial},
  journal = {American Journal of Psychiatry and Neuroscience},
  volume = {5},
  number = {3},
  pages = {31-36},
  doi = {10.11648/j.ajpn.20170503.11},
  url = {https://doi.org/10.11648/j.ajpn.20170503.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajpn.20170503.11},
  abstract = {Hemiplegia and hemiparesis are the most common deficits caused by stroke. A few small clinical trials suggest that Fluoxetine enhances motor recovery but its clinical efficacy is unknown in our setting. A randomized placebo-controlled trial was conducted at Neurology and medicine ward of Chittagong Medical College Hospital from 1/1/2013 to 31/12/2013. One hundred and twenty eight patients, aged between 40-60 years with a diagnosis of acute ischaemic stroke who fulfilled the defined inclusion and exclusion criteria were selected for the study. Eligible patients were randomly assigned, using a simple lottery method, in a 1:1 ratio to Fluoxetine (20 mg once per day, orally) or placebo group for 3 months starting within 10 days after the onset of stroke. The primary outcome was the mean change in the Rivermead Mobility Index (RMI) score between inclusion (day 0) and day 90. RMI score was significantly changed from D 0 to D 90 in Fluoxetine group in comparison to placebo group (p <.001) and mean (±SD) improvement of RMI score in 90 days were significantly greater in the Fluoxetine group, than in the placebo group [7.08 (±3.26) vs. 4.40 (±2.53)]. Patients treated with Fluoxetine were nearly 3.2 times more likely to show motor improvement than placebo group and the NNT was 2. In patients with acute ischaemic stroke and with motor deficit, the early administration of Fluoxetine with physiotherapy enhanced motor recovery after 3 months.},
 year = {2017}
}

Copy | Download

TY  - JOUR
T1  - Fluoxetine for Motor Recovery After Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial
AU  - Mahfuzur Rahman Babul
AU  - Hassanuzzaman
AU  - Zaman Ahammed
AU  - Anwarul Kibria
AU  - Golam Faruk
AU  - Akramul Azam
AU  - Mizanur Rahman
Y1  - 2017/05/31
PY  - 2017
N1  - https://doi.org/10.11648/j.ajpn.20170503.11
DO  - 10.11648/j.ajpn.20170503.11
T2  - American Journal of Psychiatry and Neuroscience
JF  - American Journal of Psychiatry and Neuroscience
JO  - American Journal of Psychiatry and Neuroscience
SP  - 31
EP  - 36
PB  - Science Publishing Group
SN  - 2330-426X
UR  - https://doi.org/10.11648/j.ajpn.20170503.11
AB  - Hemiplegia and hemiparesis are the most common deficits caused by stroke. A few small clinical trials suggest that Fluoxetine enhances motor recovery but its clinical efficacy is unknown in our setting. A randomized placebo-controlled trial was conducted at Neurology and medicine ward of Chittagong Medical College Hospital from 1/1/2013 to 31/12/2013. One hundred and twenty eight patients, aged between 40-60 years with a diagnosis of acute ischaemic stroke who fulfilled the defined inclusion and exclusion criteria were selected for the study. Eligible patients were randomly assigned, using a simple lottery method, in a 1:1 ratio to Fluoxetine (20 mg once per day, orally) or placebo group for 3 months starting within 10 days after the onset of stroke. The primary outcome was the mean change in the Rivermead Mobility Index (RMI) score between inclusion (day 0) and day 90. RMI score was significantly changed from D 0 to D 90 in Fluoxetine group in comparison to placebo group (p <.001) and mean (±SD) improvement of RMI score in 90 days were significantly greater in the Fluoxetine group, than in the placebo group [7.08 (±3.26) vs. 4.40 (±2.53)]. Patients treated with Fluoxetine were nearly 3.2 times more likely to show motor improvement than placebo group and the NNT was 2. In patients with acute ischaemic stroke and with motor deficit, the early administration of Fluoxetine with physiotherapy enhanced motor recovery after 3 months.
VL  - 5
IS  - 3
ER  -

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