When would you consider neuro-stimulants in post-stroke patients?
Is there management guidance on when to start after stroke onset?
Answer from: at Academic Institution
To my knowledge, there are no large, randomized trials supporting the use of neurostimulants in stroke rehabilitation. When patients are too sleepy to participate in therapy, I have been known to use very low-dose methylphenidate or modafinil. Levodopa has also been tried with mixed results.
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Answer from: at Community Practice
To address post-stroke fatigue, modafinil has been studied in two small double-blind randomized clinical trials in different settings. One small RCT of 41 patients tested mostly early after stroke within 2 weeks (Poulsen et al., PMID 26534969) and reported safety and improved fatigue scale. Another ...
Answer from: at Community Practice
I only consider a stimulant for patients with arousal issues from mid-brain or thalamic strokes. The data is not robust, but I'll try modafinil to see if there is any improvement.