The impact of the pharmacotherapy on stroke recovery. A retrospective cohort study

Abstract

Stroke represents a leading cause of worldwide disability with a reduced quality of life and participation to work, family and social life activities. During the recovery stage, several approaches have been studied to enhance the processes underlying spontaneous recovery, among which drugs, such as the dopaminergic or serotoninergic agents. Conversely, several classes of drugs have been proposed to have a detrimental effect on recovery, such as the anticholinergic agents, anticonvulsants, neuroleptics and GABAergic agents. The aim of this study is to evaluate the possible association between drug assumption during an inpatient rehabilitation and functional recovery after stroke. Specifically, we hypothesized that there is a different use of antidepressants (positive effect) or GABAergic, anticholinergic agents and neuroleptics (negative effect) in patients with different level of functional recovery. We included in the study subjects (aged > 18 y) who underwent a stroke multidisciplinary rehabilitation program at Ferrara University Hospital. We categorized them into good responders (GR) or poor responders (PR) according with their functional improvement, measured by the Functional Independence Measure (FIM) score. From digital medical records, we extrapolated clinical, demographic data, the total FIM score and the drugs assumed. We enrolled 181 subjects (76 female), age 65.30 ± 13.27 y, with a diagnosis of ischemic ( n = 118) or hemorrhagic stroke ( n = 63). Antidepressants were assumed by 40.98% of the PR group and the 20.83% of the GR group ( P = 0.004); Benzodiazepine were taken by 31.15% of the PR group compared with the 15% of the GR group ( P = 0.01). Anticholinergic agents were assumed by 31.15% of the PR group compared with the 12.50% of the GR group ( P = 0.002). Benzodiazepines and anticholinergic agents may play a negative role on functional recovery after stroke.