Swayne, Orlando B;
Gorgoraptis, Nikos;
Leff, Alex;
Ajina, Sara;
(2022)
Exploring the use of dopaminergic medication to treat hemispatial inattention during in-patient post-stroke neurorehabilitation.
Journal of Neuropsychology
, 16
(3)
pp. 518-536.
10.1111/jnp.12276.
Preview |
Text
Leff_JNP 1st revision_clean.pdf Download (496kB) | Preview |
Abstract
Hemispatial inattention (HSI), a lateralised impairment of spatial processing, is a common consequence of stroke. It is a poor prognostic indicator for functional recovery and interferes with the progress during in-patient neurorehabilitation. Dopaminergic medication has shown promise in improving HSI in the chronic post-stroke period but is untested in more acute settings, e.g. during in-patient neurorehabilitation. We audited the use of dopaminergic medication in ten sequential patients with post-stroke HSI, on an open-label exploratory basis. Patients' response to medication was assessed individually, using a three-week Off-On-Off protocol. We employed a mixture of bedside and functional measures, and made a multidisciplinary judgement of efficacy in individual patients. In six out of 10 patients, there was a convincing improvement of HSI while on medication, which reversed when it was paused. There was a mean 57% relative increase in target detection in the star cancellation test on the most affected side (on vs. off medication). In the six responders, medication was therefore continued throughout their admission without adverse effects. The star cancellation test was sensitive to HSI in most patients but in two cases failed to detect changes that were picked up by a functional assessment (Kessler Functional Neglect Assessment Protocol). We found this multidisciplinary approach to be feasible in an in-patient neurorehabilitation setting. We suggest further research to explore the efficacy of dopaminergic medication in improving neurorehabilitation outcomes for patients with post-stroke HSI. We suggest that more detailed N-of-1 assessments of treatment response, with internal blinding, may be a productive approach.
| Type: | Article |
|---|---|
| Title: | Exploring the use of dopaminergic medication to treat hemispatial inattention during in-patient post-stroke neurorehabilitation |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/jnp.12276 |
| Publisher version: | https://doi.org/10.1111/jnp.12276 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | cognition, dopamine, hemispatial inattention, neurorehabilitation, spatial neglect, stroke |
| UCL classification: | 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 > Brain Repair and Rehabilitation UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10147188 |
Archive Staff Only
 |
View Item |
