Effect of GABAergic treatments on cortical plasticity and motor learning capacity in the subacute phase after stroke: a single-case experimental study (GABAPLAST)

Prior treatment

• Current or recent treatment ( > 7 days) with a gabaergic drug of interest (oxazepam, gabapentin, baclofen)
• Need to introduce the planned drug immediately: - Oxazepam: severe anxiety or panic attack requiring immediate treatment; severe depressive episode; current suicidal ideation or identified suicide risk; psychological distress considered by the investigator to be incompatible with an observation period of up to 15 days; - Baclofen: severe, painful or rapidly progressive spasticity requiring immediate introduction of systemic drug therapy; - Gabapentin: severe or insufficiently controlled neuropathic pain requiring immediate drug therapy.

Lab values

• Contraindication to the planned medicine: - Oxazepam: severe respiratory failure, untreated sleep apnoea syndrome, acute or chronic severe hepatic impairment, myasthenia gravis, hypersensitivity to oxazepam or any of the excipients, galactose intolerance, total lactase deficiency or glucose-galactose malabsorption syndrome; - Baclofen: hypersensitivity to baclofen or any of the excipients, wheat allergy or celiac disease; - Gabapentin: hypersensitivity to gabapentin or any other excipient, galactose intolerance, total lactase deficiency or glucose-galactose malabsorption
  • Presence of a major peripheral neuromuscular disorder (e.g. severe motor neuropathy) making the interpretation of PEM unreliable.
  • Guardianship, curatorship, safeguarding of justice
  • Current or recent treatment ( > 7 days) with any prohibited treatment (benzodiazepine, Z-drug, morphine, pregabalin, sedative antipsychotic or barbiturate).
  • History of neurological disorders other than stroke, for example: neurodegenerative disease, multiple sclerosis, epilepsy, brain tumour, hydrocephalus.
  • History of severe psychiatric conditions, such as schizophrenia or bipolar disorder
  • pregnancy or breast-feeding
  • Presence of dependence on a psychoactive substance
  • Skin disorder in the stimulated hand indicating the placement of electromyographic collection or stimulation electrodes

Other

• Medical contraindications for the performance of MSDs according to the TMS safety questionnaire in Appendix 3

• Adults aged 18 and over
• Confirmed diagnosis of ischaemic or haemorrhagic stroke, subacute (defined as 2 weeks to 6 months after stroke).
• Presence of a non-urgent indication at the introduction of a gabaergic treatment, for which the delay of introduction provided for in the protocol is considered medically acceptable by the investigator.
• The PGI-S of the symptom associated with the indication is greater than or equal to 2.
• Sufficient understanding to participate in the study: BDAE > 3 score.
• Performing an MRI during routine care at the time of stroke diagnosis (allowing neuronavigation)
• Absence of motor impairment on the non-paretic hand
• affiliation with a national health insurance system
• Free, informed and written consent signed by the participant and the investigator (at the latest on the day of inclusion and before any review required by the research).