ABSTRACT NUMBER: ESOC2026A233 TRAJECTORY OF MOTOR RECOVERY FOLLOWING ISCHEMIC VS HAEMORRHAGIC STROKE: A POST-HOC ANALYSIS OF THE ESTREL RANDOMIZED TRIAL

Abstract Background and aims Whether motor recovery trajectories following intracerebral haemorrhage (ICH) and ischemic stroke (IS) differ is unknown. Methods Post-hoc analysis of the ESTREL (Enhancement of Stroke Rehabilitation with Levodopa) randomized controlled trial that enrolled patients with ICH or IS with unilateral motor hemiparesis. Primary outcome was motor recovery, assessed serially using the Fugl-Meyer motor Assessment (FMA) at baseline, 5 weeks, 3, 6 and 12 months and analyzed as repeated measure using adjusted multivariable mixed-effects models to compare trajectories over time between IS and ICH. Patients with at least two FMA evaluations during the 1-year follow-up were included. Results Of 610 participants, 34 were excluded: 14 due to death, 11 due to consent withdrawal, and 9 for other reasons, leaving 576 eligible for analysis (493 IS, 83 ICH). The median age was 73 years, 40% were female, and the median National Institutes of Health Stroke Scale score was 7. Overall, FMA total score was 34 [15–55] at baseline and increased significantly over time (p<0.001) across both groups. The trajectories of motor recovery differed according to stroke type (pinteraction<0.001), with a 5.2 (95%-CI 1.5-8.8) FMA points greater early motor recovery from baseline to 5 weeks following ICH than IS. Recovery trajectories beyond 5 weeks up to one year were comparable between both groups. Conclusions Motor recovery up to 1 year was greater following ICH than IS, mostly due to early gains within the first 5 weeks. These findings challenge prognostic pessimism in ICH and may inform delivery of care and future research. Conflict of interest Trüssel Simon: Nothing to disclose, Josefine Kaufmann: Nothing to disclose, Christopher Tränka: Nothing to disclose, Henrik Gensicke: nothing to disclose, Alexandros Polymeris: Nothing to disclose, David Seiffge: Nothing to disclose, Janis Rauch: Nothing to disclose, Stefan Engelter: Nothing to disclose Figure 1 - belongs to Results