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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe Multicenter Randomized Double-Blind Placebo-Controlled Trial with Fluoxetine on Motor Rehabilitation After Acute Ischemic Stroke [FLAME; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00657163\u0026amp;atom=%2Fspmdc%2F11%2F1%2F13.atom\u0022\u003ENCT00657163\u003C\/a\u003E] trial, showed that the early use of fluoxetine in addition to physiotherapy in patients with severe motor deficit resulting from ischemic stroke enhances motor recovery after 3 months.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EIschemia\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EFran\u00e7ois Chollet, MD, Centre Hospitalier Universitaire de Toulouse, Toulouse, France, presented data from the Multicenter Randomized Double-Blind Placebo-Controlled Trial with Fluoxetine on Motor Rehabilitation After Acute Ischemic Stroke (FLAME; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00657163\u0026amp;atom=%2Fspmdc%2F11%2F1%2F13.atom\u0022\u003ENCT00657163\u003C\/a\u003E) trial, showing that in patients with severe motor deficit resulting from ischemic stroke, early use of fluoxetine in addition to physiotherapy enhances motor recovery after 3 months.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAnimal studies indicate that serotonergic neurons can modulate motor output [Jacobs BL and Fornal CA. \u003Cem\u003ECurr Opin Neurobiol\u003C\/em\u003E 1997], exert a neuroprotective effect in the postischemic brain [Lim CM et al. \u003Cem\u003EJ Neurosci Res\u003C\/em\u003E 2009], and promote hippocampal neurogenesis after stroke [Li WL et al. \u003Cem\u003EJ Neurosci Res\u003C\/em\u003E 2009]. Similar results have been reported in a few small clinical trials [Pariente J et al. \u003Cem\u003EAnn Neurol\u003C\/em\u003E 2001; Dam M et al. \u003Cem\u003EStroke\u003C\/em\u003E 1996; Zittel S et al. \u003Cem\u003ENeurorehabil Neural Repair\u003C\/em\u003E 2008; Gerdelat-Mas A et al. \u003Cem\u003ENeuroimage\u003C\/em\u003E 2005].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EFLAME was a double-blind, placebo-controlled trial of 118 patients with hemiparesia or hemiplegia that resulted from ischemic stroke and a Fugl-Meyer motor scale score (FMMS; a validated scale exclusively testing motricity in an analytical and global manner) \u226455 from nine stroke centers in France. Subjects were randomly assigned to once-daily treatment with fluoxetine 20 mg (n=59) or placebo (n=59), starting 5 to 10 days after stroke onset and continuing for 3 months. All subjects also received physiotherapy and standard care. The primary study endpoint was change in FMMS score between baseline and Day 90. Secondary outcomes included score changes in the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS), and the Montgomery-\u00c5sberg Depression Rating Scale (MADRS) between baseline and Day 90.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ESubjects in the fluoxetine group were slightly older than those in the placebo group (mean age 66.4 years vs 62.9 years) and more likely to have had a prior stroke (16.9% vs 6.8% of placebo subjects). Baseline mean FMMS score was 13.4 (+8.8) and 17.1 (+11.7) in the placebo and fluoxetine groups, respectively, a significant difference that was adjusted for in the analysis.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EFMMS score progression at Day 90 was significantly (p=0.003) greater in the fluoxetine group (+34.0; 95% CI, 29.7 to 38.4) than in the placebo group (+24.3; 95% CI, 19.9 to 28.7), with the majority of benefit being seen for the upper limb part of the scale (+22.9 for fluoxetine; +13.1 for placebo; p=0.002; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). Overall, there was no difference in NIHSS or MADRS score between the two groups; however, when only the motor portion of the NIHSS was considered, there was a significant (p=0.012) improvement, favoring fluoxetine. The number of independent patients (mRS score of 1\u20132) was significantly higher in the fluoxetine group at Day 90 than in the placebo group (26.3% [n=15] vs 8.9% [n=5]; p=0.015; Table1). Fluoxetine was well tolerated; a slight, positive effect on mood was detected, as indicated by a reduction in mean adjusted MADRS score (\u22120.1 [SD= \u20132.1 to 1.9]).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12226\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12226\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12226\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EPrimary Outcome: Change in FMMS Score Baseline to Day 90.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EProf. Chollet noted that although the FLAME trial was limited by its small size, the short-term nature of the trial and the fact that it was conducted in a group of patients who were specifically selected for having a severe motor deficit render the study treatment a new and promising therapeutic approach. The treatment target is neural plasticity, for which the only existing validated treatment is arterial deocclusion with IV thrombolytic agents. Fluoxetine is well tolerated and can potentially be given to a large cohort of patients at a reasonable cost and without the need for advanced treatment facilities.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/1\/13.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn4bp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzn4bp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}