Guanfacine for the Treatment of Spatial Neglect and Impaired Vigilance

• Research type

  Research Study

• Full title

  A trial of Guanfacine, an alpha 2 adrenergic agonist, for Spatial Neglect and Impaired Vigilance following Stroke and Focal Brain Damage

• Sponsor organisation

  Imperial College London

• Eudract number

  2008-001160-36D

• ISRCTN Number

  not known

• Research summary

  Approximately 50% of patients with strokes affecting the right side of the brain suffer from spatial neglect. This syndrome causes patients to be unaware of people, objects and events on their left side. Patients with spatial neglect are less likely to fully recover or gain independence and have difficulties in many normal activities such as reading, getting around, dressing and washing. Although the syndrome has been extensively studied, there are no widely recognised effective therapies.Patients with right-sided brain damage also have reduced levels of arousal and vigilance. This has been shown to be associated with worse neglect, and when vigilance is boosted (eg. by playing regular alerting noises) the severity of neglect is temporarily improved. It may be possible to treat neglect and impaired vigilance by boosting arousal and vigilance with drug therapy. One drug that has been shown to improve vigilance in healthy volunteers and other patient groups is guanfacine, a drug that was originally used to treat high blood pressure. This oral medication improves attention in healthy individuals and is effective in the treatment of attention deficit hyperactivity disorder. In a previous pilot study which we published, we found that guanfacine improved vigilance and neglect in two patients who had left neglect, whereas in a third patient there was no such improvement. These results suggest that it may have a role in the treatment of neglect, but a further study examining a larger number of patients is necessary in order to find out whether this is actually the case. We plan to give a single dose of guanfacine to 20 patients with neglect and compare its effects on neglect and vigilance with the effects of placebo. If guanfacine does improve neglect, it would have major implications for the treatment of patients with this disabling syndrome.

• REC name

  London - Fulham Research Ethics Committee

• REC reference

  09/H0711/5

• Date of REC Opinion

  21 Jan 2009

• REC opinion

  Favourable Opinion