RESUMO
Homonymous hemianopsia (HH) is a common adverse outcome after stroke. Spontaneous improvement more than 6 months poststroke is thought to be unlikely, and traditional visual rehabilitation techniques lack clear evidence of efficacy. The case presented is of a 22-year-old woman who demonstrated improved compensation of her stroke-induced HH after the initiation of a selective serotonin reuptake inhibitor (SSRI). There is evidence supporting the use of SSRIs to improve poststroke cognitive impairment, motor impairment, and depression. This is the first case, however, demonstrating the potential novel use SSRIs to improve HH compensation after stroke, to our knowledge. LEVEL OF EVIDENCE: V.
Assuntos
Cognição/efeitos dos fármacos , Hemianopsia/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Acidente Vascular Cerebral/complicações , Doença Crônica , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Hemianopsia/diagnóstico por imagem , Hemianopsia/etiologia , Humanos , Imageamento por Ressonância Magnética/métodos , Medição de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To determine whether dose-specified botulinum toxin type A (BTX-A) and a standardized exercise protocol produce better upper extremity function than placebo and the same exercise program. DESIGN: Double-blind randomized trial. SETTING: A rehabilitation research center. PARTICIPANTS: A convenience sample of patients (N=25, age range, 23-76 y) who sustained a stroke 3 to 24 months previously but could initiate wrist extension. INTERVENTIONS: Participants were randomly selected to receive either BTX-A (maximum 300 U) or saline, followed by 12 to 16 exercise sessions. MAIN OUTCOME MEASURES: The primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcome measures included the Modified Ashworth Scale (MAS), active range of motion, and the Stroke Impact Scale (SIS; quality of life). RESULTS: There were no group-by-time interactions for changes in the WMFT and no treatment difference (P=.86), although the BTX-A group could complete more tasks governing proximal joint motions. MAS scores improved for the BTX-A group and worsened for the control group after injection (P=.02), as did the SIS emotion domain (P=.035). CONCLUSIONS: Among chronic stroke survivors, BTX-A did not impact function, movement, or tone more than a standardized exercise program.
