Randomised, double-blind, placebo-controlled crossover study of single-dose guanfacine in unilateral neglect following stroke
Randomised, double-blind, placebo-controlled crossover study of single-dose guanfacine in unilateral neglect following stroke
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DOI：
10.1136/jnnp-2017-317338
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发表时间：
2018-06-01
影响因子：
11
通讯作者：
Malhotra, Paresh A.
中科院分区：
文献类型：
--
作者：
Dalmaijer, Edwin S.;Li, Korina M. S.;Malhotra, Paresh A.
目的单侧忽视是脑卒中后的一种障碍性疾病，对脑卒中后的功能恢复有不良影响，目前尚无有效的治疗方法。这种多成分综合征的特征是注意力偏离对侧空间，以及几个认知领域的障碍，包括持续注意力和空间工作记忆。这项研究的目的是测试胍法辛，去甲肾上腺素能α-2A激动剂，改善方面的neglect.Methods十三右半球中风患者，包括在一个随机的，双盲的，安慰剂对照的概念验证交叉研究，检查单剂量的胍法辛的影响。患者进行了测试的计算机化，有时间限制的取消范例，以及任务，独立评估持续的注意力和空间工作memory.Results的guanfacine，有一个统计学上的显着改善，发现在取消任务的目标总数相比，安慰剂（平均改善5，出了可能的64）。然而，没有证据表明忽视患者的方向性注意偏差发生了变化。此外，贝叶斯统计分析揭示了可靠的证据，对任何影响guanfacine搜索组织和性能上我们的持续注意力和空间工作记忆tasks.Conclusions Guanfacine提高搜索忽视的目标，但没有影响的方向偏差或搜索组织，也没有提高持续的注意力或工作记忆的独立任务。进一步的工作是必要的，以确定是否长期治疗与胍法辛可能是有效的一些忽视患者，它是否影响功能的结果措施。
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.