Levodopa or dopamine agonists for enhancing motor function after stroke.
Andrea S Jauslin, Lukas Boos, Julian Hirt et al.
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In 30 seconds
This Cochrane systematic review and meta-analysis assessed whether levodopa or dopamine agonists improve motor function after stroke. It included 12 randomised controlled trials involving 1860 participants; 11 trials studied levodopa and one studied ropinirole. The review found no clear motor-function benefit over placebo or usual care. For continuous motor outcomes, the pooled estimate was SMD 1.42 (95% CI -0.20 to 3.05; 6 trials, 1258 participants), with very low-certainty evidence and substantial heterogeneity. A sensitivity analysis of two low-risk-of-bias trials found SMD 0.02 (95% CI -0.10 to 0.14; 1025 participants).
Key findings
- Continuous motor outcomes showed no detected difference: SMD 1.42 (95% CI -0.20 to 3.05; 6 trials, 1258 participants; very low-certainty evidence).
- For dichotomous motor outcomes, the pooled result was RR 0.93 (95% CI 0.82 to 1.06; 2 trials, 615 participants; low-certainty evidence).
- In two trials at low risk of bias, the estimate was SMD 0.02 (95% CI -0.10 to 0.14; 1025 participants), with no heterogeneity (I² = 0%).
Why it matters
Dopaminergic drugs have been investigated as a way to enhance motor recovery after stroke, but this review found no clear evidence of benefit. The imprecision and, for the main continuous outcome, substantial heterogeneity mean the pooled estimate should be interpreted cautiously. The findings help clarify that efficacy for post-stroke motor recovery remains uncertain rather than established.
What to keep in mind
Evidence certainty was very low for continuous motor outcomes and low for dichotomous outcomes. The continuous-outcome analysis had substantial heterogeneity (I² = 99%) and wide confidence intervals.