The effect of lithium in enhancing post-stroke motor recovery: A double-blind, placebo-controlled, randomized clinical trial

S.A. Sajedi, S.E. Mohammadianinejad, N. Majdinasab, F. Abdollahi, M. Masoudi Moqaddam, F. Sadr

Background: Evidences from cultured cells and animal models of ischemia suggested that lithium has neuroprotective and neurotrophic effects and may play a desirable role in reducing infarct volume and improving the brain insults from stroke.

Objective: The aim of the study was t/INS;o evaluate the efficacy of lithium in motor recovery after ischemic stroke with focus on distal upper limb motor recovery.

Material and methods: This was a placebo-controlled, double-blind, and randomized clinical trial on 80 patients with first ever stroke, allocated randomly in lithium 300 mg/twice daily or placebo. Treatment was initiated 48 h after stroke and continued for 30 days. Modified National Institute of Health Stroke Scale (mNIHSS) and hand subsection of Fugl-Meyer Assessment (hFMA) were used to evaluate impairment on the 5th and 30th of treatment.

Results: 66 subjects completed the study, including 32 subjects in lithium and 34 in placebo group. In general, there were no statistically significant difference in the improvement in mNIHSS (p = 0.40) and hFMA (p = 0.07) after 30 days. However, a subgroup analysis showed that patients with cortical strokes in lithium group had significantly better improvement in both mNIHSS and hFMA in comparison to placebo group (p = 0.003). About 44% (n = 14) of patients in lithium group, mainly from cortical stroke subgroup, regained more than 25% of full function based on hFMA, while this rate in placebo group was 14.7% (n = 5)(p = 0.009).

Conclusion: We observed some promising effect from lithium in enhancing recovery in cortical sub-group of ischemic stroke. Larger trial with more cortical stroke patients is needed to better investigate this effect.