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Pharmacological therapies in post stroke recovery: recommendations for future clinical trials

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Abstract

Stroke is a leading cause of serious long-term disability in adults and is the second leading cause of death worldwide. Early reperfusion and neuroprotection techniques have been the focus of much effort with the aim of very acute treatment of the stroke. Targeting different mechanisms, pharmacological therapies have the potential to reduce disability in a large fraction of patients who survive the acute stroke. The brain’s capacity to reorganize after stroke through plasticity mechanisms can be modulated by pharmacological agents. A number of therapeutic interventions are under study, including small molecules, growth factors, and monoclonal antibodies. Recently it has been shown that the SSRI fluoxetine improved motor deficit in patients with ischaemic stroke and hemiplegia which appeared to be independent of the presence of depression. In this context, it is of major importance to support innovative research in order to promote the emergence of new pharmacological treatments targeting neurological recovery after stroke, as opposed to acute de-occlusion and neuroprotection. This paper is the work of a group of 14 scientists with aim of (1) addressing key areas of the basic and clinical aspects of human brain plasticity after stroke and potential pharmacological targets for recovery, (2) asking questions about the most appropriate characteristics of clinical trials testing drugs in post stroke recovery and (3) proposing recommendations for future clinical trials.

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Acknowledgments

We deeply thank the “Institut de Recherche Pierre Fabre”, particularly Dr. L Mansuy, Dr. E André, Mr. P Sokoloff and Mr. JP Caubère to have accepted to sponsor the workshop. Sponsoring of the 2012 workshop by “Institut de Recherche Pierre Fabre”.

Conflicts of interest

FC received honoraria from Servier and has consultancy for IRPFabre. SC is PI for a NIH grant, received speaker horaria from Sanofi, Pierre Fabre, Genentech, Asubic, has consultancy for GlaxoSmithKline and Pfizer. CS is PI for a Health Research Council and Neurological Foundation grant and received honoraria for examination fees. JK received payment for speakers’ bureau Bayer and Boeheringer and has consultancy for Boehringer. JCB: no disclosure. CW is PI for Deutsch Foundation G, worked as expert witness, has consultancy for Pierre Fabre. MH received payment for speakers’ bureau appointment. PA is PI for a French Ministry of Heath grant, worked as expert withness in legal assessments and received honoraria from IRPF. US: no disclosure. TM: no disclosure. JT received honoraria and has consultancy for IRPF. MV: no disclosure. SM: received honoraria from Astra Zeneca, Lundbeck, Pfizer, Servier, Pierre Fabre and has consultancy for Richter, Sanofi, Takeda. HAis PI for NINDS, Merck and Medtronic grant, received honoraria from IRPFabre.

Author information

Authors and Affiliations

  1. UPS, Imagerie Cérébrale et Handicaps Neurologiques UMR 825, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, Toulouse, France

    F. Chollet

  2. Departments of Neurology and Anatomy and Neurobiology, University of California Irvine, Irvine, USA

    S. C. Cramer

  3. Department of Medicine, Centre for Brain Research, University of Auckland, Auckland, New Zealand

    C. Stinear

  4. Utrecht Stroke Centre, University Medical Centre, Utrecht, The Netherlands

    L. J. Kappelle

  5. Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK

    J. C. Baron

  6. INSERM U894, Sorbonne Paris Cité, Université Paris Descartes, Paris, France

    J. C. Baron

  7. Department of Neurology, University Medical Center, University of Freiburg, Freiburg, Germany

    C. Weiller

  8. Service de Médecine Physique et Réadaptation, AP-HP, Hôpital Raymond Poincaré, Université de Versailles-Saint-Quentin, Garches, France

    P. Azouvi

  9. University Hospital Grenoble, Grenoble, France

    M. Hommel

  10. Radiology Department, IRCCS Fondazione S. Lucia, via Ardeatina 306, 00179, Rome, Italy

    U. Sabatini

  11. CHU de Besançon, Besançon, France

    T. Moulin

  12. Clinique des Cèdres, Cornebarrieu, France

    J. Tardy

  13. Section of Clinical Epidemiology, Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy

    M. Valenti

  14. Imperial College London, London, UK

    S. Montgomery

  15. Department of Neurology, University of Iowa, Iowa, USA

    H. Adams Jr

  16. Department of Neurology, Hopital Purpan, Place Baylac, Toulouse, 31059, France

    F. Chollet

Authors
  1. F. Chollet
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  2. S. C. Cramer
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  3. C. Stinear
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  4. L. J. Kappelle
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  5. J. C. Baron
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  6. C. Weiller
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  7. P. Azouvi
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  8. M. Hommel
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  9. U. Sabatini
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  10. T. Moulin
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  11. J. Tardy
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  12. M. Valenti
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  13. S. Montgomery
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  14. H. Adams Jr
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Corresponding author

Correspondence to F. Chollet.

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Chollet, F., Cramer, S.C., Stinear, C. et al. Pharmacological therapies in post stroke recovery: recommendations for future clinical trials. J Neurol 261, 1461–1468 (2014). https://doi.org/10.1007/s00415-013-7172-z

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  • DOI: https://doi.org/10.1007/s00415-013-7172-z

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