{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:44:56Z","timestamp":1777869896249,"version":"3.51.4"},"reference-count":67,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":37,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","doi-asserted-by":"publisher","award":["33IC30_179667"],"award-info":[{"award-number":["33IC30_179667"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Post-stroke fatigue (PSF) is common and impacts stroke rehabilitation. Dopaminergic treatment may have beneficial effects on PSF. This study investigated whether levodopa, compared with placebo, was associated with a lower frequency or severity of PSF during in-hospital rehabilitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>Enhancement of Stroke Rehabilitation with Levodopa (ESTREL)-Fatigue was an exploratory analysis of secondary outcome data obtained in the multicentre, randomised, placebo-controlled ESTREL trial. Participants with acute stroke received levodopa 100\u00a0mg\/carbidopa 25\u00a0mg or placebo 3 times daily for 39\u00a0days to enhance motor recovery. Participants who (i) reported fatigue at 5\u00a0weeks and who (ii) took at least 80% of the study medication were included in ESTREL-Fatigue. No adjustments for confounding were made. The primary endpoint was the presence of PSF at 5\u00a0weeks, defined as a T-score of\u00a0\u2265\u00a055 on the Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue-Short-form-4a. As secondary endpoints, T-score cutoffs of\u00a0\u2265\u00a060 (moderate fatigue) and\u00a0\u2265\u00a070 (severe fatigue) were used. Binary logistic regression was used to compare PSF at 5\u00a0weeks between treatment groups. Results are presented as odds ratios (ORs) with 95% CI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 456 of 505 (90.3%) participants were included (levodopa\/placebo 235\/221, median age 73\u00a0years, 41% female). Post-stroke fatigue at 5\u00a0weeks was present in 63\/235 (26.8%) levodopa-treated participants and in 65\/221 (29.4%) placebo-treated participants (OR: 0.88; 95% CI, 0.58\u20131.32; risk ratio 0.91; risk difference\u00a0\u2212\u00a02.6%). For cutoffs of\u00a0\u2265\u00a060 and\u00a0\u2265\u00a070, ORs were 0.78 (95% CI, 0.43\u20131.41) and 0.8 (95% CI, 0.25\u20132.44), respectively. A sensitivity analysis as per intention-to-treat with all 610 randomised ESTREL participants also showed no significant difference in fatigue presence between levodopa and placebo groups (OR: 0.95; 95% CI, 0.65\u20131.39) and a sensitivity analysis using a mixed-effects logistic regression showed no evidence of centre-related clustering.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In ESTREL-Fatigue, levodopa, compared to placebo, was not associated with less PSF during in-hospital rehabilitation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/esj\/aakag029","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T16:08:11Z","timestamp":1775750891000},"source":"Crossref","is-referenced-by-count":0,"title":["ESTREL-Fatigue\u2014association of levodopa with post-stroke fatigue"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2383-881X","authenticated-orcid":false,"given":"Lukas","family":"Boos","sequence":"first","affiliation":[{"name":"Departement of Rehabilitation and Neurology, University Department of Geriatric Medicine FELIX PLATTER, University of Basel , Basel ,","place":["Switzerland"]},{"name":"Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel and University of Basel , Basel ,","place":["Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7744-2796","authenticated-orcid":false,"given":"Josefin E","family":"Kaufmann","sequence":"additional","affiliation":[{"name":"Departement of Rehabilitation and Neurology, University Department of Geriatric Medicine FELIX PLATTER, University of Basel , Basel ,","place":["Switzerland"]},{"name":"Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel and University of Basel , Basel ,","place":["Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5598-6249","authenticated-orcid":false,"given":"Mirjam I","family":"Sauter","sequence":"additional","affiliation":[{"name":"Departement of Rehabilitation and Neurology, University Department of Geriatric Medicine FELIX PLATTER, University of Basel , Basel ,","place":["Switzerland"]},{"name":"Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel and University of Basel , Basel ,","place":["Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1435-1114","authenticated-orcid":false,"given":"Philippe","family":"Lyrer","sequence":"additional","affiliation":[{"name":"Departement of Rehabilitation and Neurology, University Department of Geriatric Medicine FELIX PLATTER, University of Basel , Basel ,","place":["Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4362-2497","authenticated-orcid":false,"given":"Annaelle","family":"Zietz","sequence":"additional","affiliation":[{"name":"Departement of Rehabilitation and Neurology, University Department of Geriatric Medicine FELIX PLATTER, University of Basel , Basel ,","place":["Switzerland"]},{"name":"Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel and University of Basel , Basel ,","place":["Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2537-855X","authenticated-orcid":false,"given":"Simon","family":"Tr\u00fcssel","sequence":"additional","affiliation":[{"name":"Departement of Rehabilitation and Neurology, University Department of Geriatric Medicine FELIX PLATTER, University of Basel , Basel ,","place":["Switzerland"]},{"name":"Department of Neurology and Stroke 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