GABAergic drug use and global, cognitive, and motor functional outcomes after stroke

A J-P Schwitzguébel; C Benaïm; S Carda; A M Torea Filgueira; R Frischknecht; P-A Rapin

doi:10.1016/j.rehab.2016.03.007

GABAergic drug use and global, cognitive, and motor functional outcomes after stroke

Ann Phys Rehabil Med. 2016 Dec;59(5-6):320-325. doi: 10.1016/j.rehab.2016.03.007. Epub 2016 Apr 26.

Authors

A J-P Schwitzguébel¹, C Benaïm², S Carda³, A M Torea Filgueira⁴, R Frischknecht³, P-A Rapin⁴

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Nestlé Hospital, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: adrien.schwitzguebel@gmail.com.
² Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital, Lausanne University Hospital, Lausanne, Switzerland; Institute for Research in Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland.
³ Department of Physical Medicine and Rehabilitation, Nestlé Hospital, Lausanne University Hospital, Lausanne, Switzerland.
⁴ Service of Neurologic Rehabilitation, Institution de Lavigny, Lavigny, Switzerland.

PMID: 27132886
DOI: 10.1016/j.rehab.2016.03.007

Abstract

Background: In animal models and healthy volunteers, the use of GABA A receptor agonists (GABA-AGs) seem deleterious for functional recovery. The agents are widely used for subacute stroke, but their effect on functional recovery remains unclear.

Objectives: We aimed to evaluate the association between GABA-AG use and functional recovery after stroke.

Methods: We retrospectively recruited 434 survivors of subacute stroke admitted for inpatient rehabilitation between 2000 and 2013 in our institution (107 with and 327 without GABA-AG use). We used multivariate regression to assess the association of GABA-AG use and successful functional recovery, defined as reaching, between admission and discharge, the minimal clinically important difference (MCID) of 22 points on the global Functional Independence Measure (FIM). Secondary analyses were the associations of GABA-AG with cognitive and motor FIM MCID and constant GABA-AG exposure (24h/24 GABA-AG) with global, cognitive and motor FIM MCID. A new estimation of the MCID was performed with the standard error of measurement.

Results: Reaching the global FIM MCID was associated with GABA-AG use (adjusted odds ratio [aOR] 0.54 [95% CI 0.31-0.91], P=0.02) as well as 24h/24 GABA-AG use (aOR 0.25 [0.08-0.83]; P=0.02). Furthermore, GABA-AG and 24h/24 GABA-AG use was inversely but not always significantly associated with reaching the cognitive FIM MCID (aOR 0.56, P=0.07; aOR 0.26, P=0.06, respectively) and motor FIM MCID (aOR 0.51, P=0.07; aOR 0.13, P=0.01, respectively). The estimated MCID was 19 for global FIM, 4 for cognitive FIM, and 16 for motor FIM.

Conclusions: GABA-AG use is associated with not reaching successful functional recovery during stroke rehabilitation. Randomised trials are needed to formally establish the potential deleterious effect of GABA-AG use on functional recovery.

Keywords: Benzodiazepines; Functional independence measure; GABA-A receptor agonists; Minimal clinically important difference; Recovery; Rehabilitation; Stroke.

Publication types

Evaluation Study

MeSH terms

Adult
Aged
Aged, 80 and over
Cognition / drug effects
Disability Evaluation
Female
GABA-A Receptor Agonists / adverse effects
GABA-A Receptor Agonists / pharmacology*
Humans
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Recovery of Function / drug effects*
Regression Analysis
Retrospective Studies
Stroke / drug therapy*
Stroke / psychology
Stroke Rehabilitation / methods*
Survivors / psychology*
Treatment Outcome

Substances

GABA-A Receptor Agonists