Escitalopram promotes recovery from hand paresis in cortical sensori- motor stroke – a randomized, double-blind, placebo-controlled longitudinal study

This study investigated the effects of escitalopram on hand motor recovery in patients who experienced a first-ever sensorimotor stroke involving the pre- or postcentral gyrus. fMRI was employed while participants performed a strictly within-hand motor task to assess recovery. Behavioral measures were performed as well. The primary objective was to determine whether early escitalopram administration within the first three months post-stroke enhances hand motor recovery compared to placebo. A secondary aim was to explore the neural reorganization associated with the motor action. Methods : In a double-blind, placebo-controlled study, motor dexterity was evaluated using a motor task embedded within an imitation procedure performed during the fMRI at baseline, three months, and nine months post-stroke. Participants were randomly assigned to receive either escitalopram or placebo for the first three months. The imitation task required participants to observe and execute grasping and regrasping movements. Results : The escitalopram group exhibited significant motor performance improvements in the long-term course. Increased blood oxygen level-dependent (BOLD) activity was observed in key motor-related brain regions, including the left frontal operculum (OP6), Brodmann area 44, the anterior insula, the posterior putamen, and the right premotor subarea 6v3. In contrast, the placebo group demonstrated enhanced activation in the left medio-dorsal thalamus at nine months. Conclusion : Early escitalopram treatment accelerated motor recovery, promoting activation in brain regions associated with fine motor control in the left hemisphere and spatial hand coordination in the right hemisphere. Delayed recovery in the placebo group was characterized by compensatory activation of the left dorsolateral prefrontal loop during the early chronic phase.