Post-Stroke Complications

Summary Stroke can be associated with a number of sequelae which require treatment during rehabilitation of the patient. These include aphasia, depression and emotionalism, central pain, spasticity and urinary incontinence. Patients will also require rehabilitation to optimise motor recovery. At present, no reliable evidence favours any drug for the treatment of aphasia or post-stroke urinary incontinence. On the basis of small, unconfirmed, randomised trials, a tentative recommendation can be made for the use of the anti-depressants nortriptyline, citalopram, maprotiline or fluoxetine in post-stroke depression, and nortriptyline or citalopram in post-stroke emotionalism. The tricyclic antidepressant amitriptyline appears to be useful for the control of central post-stroke pain, and botulinum toxin A should be considered for post-stroke spasticity. Although limited data suggest that amphetamine and dexamphetamine can enhance motor recovery, these drugs remain investigational and their use cannot be recommended outside of clinical trials.