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A randomised double-blind, placebo-controlled crossover study of single-dose guanfacine in unilateral neglect following stroke

Dalmaijer, ES; Li, KMS; Gorgoraptis, N; Leff, AP; Cohen, DL; Parton, A; Husain, M; (2018) A randomised double-blind, placebo-controlled crossover study of single-dose guanfacine in unilateral neglect following stroke. Journal of Neurology, Neurosurgery and Psychiatry , 89 (6) pp. 593-598. 10.1136/jnnp-2017-317338. Green open access

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Abstract

Objective: Unilateral neglect is a poststroke disorder that impacts negatively on functional outcome and lacks established, effective treatment. This multicomponent syndrome is characterised by a directional bias of attention away from contralesional space, together with impairments in several cognitive domains, including sustained attention and spatial working memory. This study aimed to test the effects of guanfacine, a noradrenergic alpha-2A agonist, on ameliorating aspects of neglect. / Methods: Thirteen right hemisphere stroke patients with leftward neglect were included in a randomised, double-blind, placebo-controlled proof-of-concept crossover study that examined the effects of a single dose of guanfacine. Patients were tested on a computerised, time-limited cancellation paradigm, as well as tasks that independently assessed sustained attention and spatial working memory. / Results: On guanfacine, there was a statistically significant improvement in the total number of targets found on the cancellation task when compared with placebo (mean improvement of 5, out of a possible 64). However, there was no evidence of a change in neglect patients’ directional attention bias. Furthermore, Bayesian statistical analysis revealed reliable evidence against any effects of guanfacine on search organisation and performance on our sustained attention and spatial working memory tasks. / Conclusions: Guanfacine improves search in neglect by boosting the number of targets found but had no effects on directional bias or search organisation, nor did it improve sustained attention or working memory on independent tasks. Further work is necessary to determine whether longer term treatment with guanfacine may be effective for some neglect patients and whether it affects functional outcome measures. / Trial registration number: NCT00955253.

Type: Article
Title: A randomised double-blind, placebo-controlled crossover study of single-dose guanfacine in unilateral neglect following stroke
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/jnnp-2017-317338
Publisher version: http://doi.org/10.1136/jnnp-2017-317338
Language: English
Additional information: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Brain Repair and Rehabilitation
URI: http://discovery.ucl.ac.uk/id/eprint/10041203
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