Abstract Number: Esoc2026a476 Levodopa as an Adjunct to Stroke Rehabilitation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract Background and aims Levodopa has been proposed as an adjunct to stroke rehabilitation; however, evidence from randomized controlled trials (RCTs) remains inconsistent. This study aimed to evaluate the efficacy of levodopa for improving motor recovery after stroke. Methods This systematic review and meta-analysis followed PRISMA guidelines. Electronic databases were searched through December 2025 for RCTs investigating levodopa as an adjunct to stroke rehabilitation. Eligible studies included stroke patients and compared levodopa, alone or combined with rehabilitation interventions, with placebo or standard care. Meta-analyses were performed using a random-effects model in RevMan. Results Of 240 records screened, 12 RCTs involving 1,606 participants met the inclusion criteria. Most studies were conducted in Europe, and two employed a crossover design. Sample sizes ranged from large multicenter trials (~600 participants) to small pilot studies (≤10 participants). Most trials assessed levodopa alone; others combined it with additional interventions. Although several small trials reported improvements in motor outcomes, the largest RCTs failed to demonstrate significant benefit over placebo. Meta-analysis of Rivermead Mobility Index or Rivermead Motor Assessment outcomes showed no significant difference between levodopa and placebo (SMD = 0.23, 95% CI −0.06 to 0.52; P = 0.13). Similarly, pooled Fugl-Meyer Assessment scores showed no significant improvement (MD = 3.5, 95% CI −5.83 to 12.82; P = 0.46). Conclusions Current evidence does not support the routine use of levodopa as an adjunct to rehabilitation therapy for enhancing motor recovery after stroke. Future studies should focus on identifying specific patient subgroups and optimal treatment strategies. Conflict of interest All authors have nothing to disclose