Effect of Serotonin and Levodopa in Ischemic Stroke

Effect of Serotonin and Levodopa Functional Recovery in Patients With Cerebral Infarction

Cortical plasticity plays a pivotal role in functional recovery after a stroke. Neurotransmitter release, facilitates the creation of new synapses and promotes brain plasticity. In a pilot study, will evaluate the potential benefit of drugs that increase the release of neurotransmitters in patients with first stroke.

Methods. Evaluate 240 consecutive patients with a first ischemic stroke with NIHSS 5-20 without aphasia and with a previous independent functional status (mRS <3). Patients will be randomized into four arms: 1) control group, 2) treatment with citalopram 20 mg / day, 3) group levodopa (sinemet plus)100 mg / day, 4) group levodopa (sinemet plus) 100 mg / day + citalopram 20 mg / day.

The treatment begins within the first 5 days of stroke and is maintained for 6 months. All patients will be treated according to current guidelines for secondary prevention. We will assess the following variables: demographic, vascular risk factors, etiologic subtypes according to TOAST criteria, neurologic deficit with the NIHSS scale, cognitive assessment with Minimental scale and functional status with scale modified Rankin at discharge, 3, 6 and 12 months, Symbol Digit Modalities Test (SDMT), GDS-15 Geriatric Depression Scale, Logical memory of WMS-IV . The cognitive assessment and motor functional status will be evaluated by a neuropsychologist and neurologist blinded to treatment assignment.

Inclusion Criteria:

• • Patients with a first stroke with NIHSS 5-20 points

  • Patients without aphasia to avoid interference in the assessment of depression and cognitive impairment
  • Patients with independent functional status prior to stroke (mRS <3)
  • Patients without prior cognitive impairment or depressive syndrome assessed by medical history with the patient and family.
  • The assigned treatment initiated within the first five days of stroke

Exclusion Criteria:

• • Patients with prior myocardial or cerebral hemorrhage

  • Patients with TIA
  • Patients with aphasia
  • History of cognitive impairment or prior depressive syndrome
  • Patients with no independent functional status mRS greater than or equal to 3
  • Underlying disease hopefully less than one year of life.
  • Patient pre-treatment with levodopa, an antidepressant or neuroleptic.