Randomised, double-blind, placebo-controlled crossover study of single-dose guanfacine in unilateral neglect following stroke

Edwin S Dalmaijer, Korina M S Li, Nikos Gorgoraptis, Alexander P Leff, David L Cohen, Andrew D Parton, Masud Husain, Paresh A Malhotra

Research output: Contribution to journalArticle (Academic Journal)peer-review


OBJECTIVE: Unilateral neglect is a poststroke disorder that impacts negatively on functional outcome and lacks established, effective treatment. This multicomponent syndrome is characterised by a directional bias of attention away from contralesional space, together with impairments in several cognitive domains, including sustained attention and spatial working memory. This study aimed to test the effects of guanfacine, a noradrenergic alpha-2A agonist, on ameliorating aspects of neglect.

METHODS: Thirteen right hemisphere stroke patients with leftward neglect were included in a randomised, double-blind, placebo-controlled proof-of-concept crossover study that examined the effects of a single dose of guanfacine. Patients were tested on a computerised, time-limited cancellation paradigm, as well as tasks that independently assessed sustained attention and spatial working memory.

RESULTS: On guanfacine, there was a statistically significant improvement in the total number of targets found on the cancellation task when compared with placebo (mean improvement of 5, out of a possible 64). However, there was no evidence of a change in neglect patients' directional attention bias. Furthermore, Bayesian statistical analysis revealed reliable evidence against any effects of guanfacine on search organisation and performance on our sustained attention and spatial working memory tasks.

CONCLUSIONS: Guanfacine improves search in neglect by boosting the number of targets found but had no effects on directional bias or search organisation, nor did it improve sustained attention or working memory on independent tasks. Further work is necessary to determine whether longer term treatment with guanfacine may be effective for some neglect patients and whether it affects functional outcome measures.


Original languageEnglish
Pages (from-to)593-598
Number of pages6
JournalJournal of Neurology, Neurosurgery, and Psychiatry
Issue number6
Publication statusPublished - 7 Feb 2018

Bibliographical note

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.


  • Adrenergic alpha-2 Receptor Agonists/therapeutic use
  • Adult
  • Aged
  • Attention
  • Cross-Over Studies
  • Double-Blind Method
  • Female
  • Guanfacine/therapeutic use
  • Humans
  • Male
  • Memory
  • Middle Aged
  • Perceptual Disorders/drug therapy
  • Stroke/complications


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