Can 'dopamine medicines' help improve movement and mobility following stroke?

Key messages

• Dopamine medicines (medications that affect the chemical messenger (neurotransmitter) dopamine) may make no difference to movement or mobility after stroke, but we are very uncertain about some of the results. The two largest and most reliable studies did not show a benefit.

• There is not enough information to draw firm conclusions about unwanted effects, but we did not find more serious unwanted effects in dopamine medicines.

• Future research should aim for larger studies and focus on specific characteristics of patients, such as what kind of problems in the brain and nervous system they show after stroke, different affected areas we can see in the imaging, and how often they have physiotherapy and what type.

What is a stroke, and how is it treated?

A stroke happens when the blood supply in the brain is suddenly interrupted, either by a blood vessel in the brain becoming blocked (called ischaemic stroke) or breaking and bleeding (called haemorrhagic stroke). This can damage brain cells and lead to weakness in the face and limbs. The effects of a stroke can vary from mild to severe, depending on the area and the amount of the brain affected. Following a stroke, people often find it hard to do everyday things, like dressing, walking, picking things up and speaking. Stroke is a leading cause of death and disability worldwide. It is most common in elderly people aged around 70 years or older, but can also occur in younger people.

Stroke treatment needs to begin immediately, either to restore blood flow or stop bleeding, depending on the type of stroke. Recovery from stroke can be slow. Rehabilitation may include physiotherapy, surgery or medication, depending on the person’s needs. Rehabilitation plays a key role in recovery and helps people regain mobility and physical strength (motor function), so that they can carry out everyday tasks and live more independently.

What are 'dopamine medicines'?

Dopamine is a hormone made in the brain that transmits messages to nerve cells. It has a key role in brain processes, such as movement, learning, and reward. Dopamine medicines are medications that affect how dopamine works. Following a stroke, they may help rebuild damaged pathways in the brain that transmit chemical and electrical signals, which may help people to relearn motor skills, like gripping and walking. They include levodopa, ropinirole and pramipexole. They may provide an inexpensive, well-known and generally well-tolerated treatment to help motor recovery after stroke, but currently there is a lack of evidence about them.

What did we want to find out?

We wanted to investigate whether dopamine medicines could help improve the recovery of movement abilities and strength during stroke rehabilitation. In particular, we looked at whether these medicines could support recovery of motor function, such as walking and mobility, and whether they caused serious unwanted effects. We were also interested in:

• the risk of death or another stroke; and

• improvements in disability, and being dependent on others.

What did we do?

We searched for studies with people who'd had a stroke, which compared dopamine medicines against placebo (medication with the same appearance, but without any active substance) or usual medical care, including rehabilitation therapies such as physiotherapy. We compared and summarised the studies' results, and rated our confidence in the evidence, based on factors such as trial methods and sizes.

What did we find?

We found 12 studies with 1860 people aged from 55 to 78 years. The studies took place in Europe, the USA and Asia, and were published between 2001 and 2025. Eleven studies investigated levodopa, and one examined ropinirole. Ten studies compared dopamine medicines against placebo and two against usual care.

• Motor function (8 studies, 1873 people): six studies (1258 people) measured change in motor function over time (studies lasted from 3 weeks to 12 months), and two studies (615 people) measured it as 'walking or not walking'. Overall, dopamine medicines may make no difference to motor function, but we are very uncertain about some of the results.

• Serious unwanted effects (6 studies, 1281 people): dopamine medicines may make no difference to the risk of serious unwanted effects.

• Dopamine medicines may make no difference to death (7 studies, 1433 people) and recurrent stroke (4 studies, 648 people).

• Dopamine medicines probably make no difference to disability (1 study, 596 people) or dependence (2 studies, 483 people).

What are the limitations of the evidence?

Our confidence in the evidence is limited because we found few, mostly small studies, and they varied widely in what they investigated and how they measured results. Few used the most robust methods – we considered only two studies to be high quality.

How up to date is this evidence?

This evidence is current to November 2025.