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The ESTREL trial showed levodopa combined with standardized rehabilitation did not improve motor recovery after stroke compared with placebo.
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Median Fugl-Meyer Assessment (FMA) scores at three months were similar between levodopa and placebo groups, with differences far below the clinically meaningful threshold.
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Functional outcomes (modified Rankin Scale, NIHSS, Rivermead Mobility Index) and quality-of-life scores (PROMIS-29, PROMIS-10) did not differ between treatment groups.
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Serious adverse events occurred at comparable rates; infections were most common, and confusion or hallucinations were frequent prespecified events of interest.
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Findings do not support routine use of levodopa as an adjunct to stroke rehabilitation despite prior meta-analysis signals of benefit.
Source: JAMA
