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(Stroke. 2002;33:639.)
© 2002 American Heart Association, Inc.

Letters to the Editor

Systematic Review of Nimodipine

Patrick D. Lyden, MD, FAAN

UCSD Stroke Center, UCSD School of Medicine, San Diego, California

To the Editor:

I noted with interest the systematic review of nimodipine from Dr. Horn et al (Stroke. 2001;32;2433–2438). The authors are to be complimented for a thorough review of difficult literature; their summary brings clarity to a previously confusing issue. I concur with their conclusions that preclinical data suggested nimodipine NOT be pursued in clinical trials.

The authors emphasized stroke infarct volume as an outcome measure. They meta-analyzed the effect of nimodipine on infarct size (their Figure 1), in which an overall favorable effect is shown for nimodipine. The "methodological score" they used to rate the quality of the reviewed articles gave a point if the article included both behavioral and morphometric outcomes.

It seems to me that this review could be taken as further indictment of morphometry as a valuable outcome measurement: infarct volume in the rodent brain seems not to predict effects either on functional outcome or in human clinical trials. This controversy has been bubbling for a while now, and this article serves to crystallize it. The only remaining arguments in favor of morphometry as an end point are (1) it is simple and (2) the data are parametric so standard statistical analysis can be used. Arguments against morphometry include (1) the variance is so huge (if it is reported honestly) that sample sizes must be increased beyond what is typically reported and (2) it has limited relevance to functional outcome. Horn et al have buttressed this latter point, perhaps unintentionally.

As we struggle to resolve the . . . [Full Text of this Article]

Philip Bath, MD, FRCP

Centre for Vascular Research, University of Nottingham, Nottingham, United Kingdom

Marc Fisher, MD

Department of Neurology, University of Massachusetts, Worcester, Massachusetts

Barbara C. Tilley, PhD

Department of Biometry & Epidemiology, Medical University of South Carolina, Charleston, South Carolina

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