Improvement of language function after Contralateral Seventh Cervical Nerve Transfer in hemiplegic patients combined with post-stroke aphasia: a prospective observational cohort study

Abstract

Background While the contralateral seventh cervical nerve (CC7) cross transfer was designed to reconstruct paralyzed arm function after stroke, improvement in language function was found in patients combined with aphasia. Objective To evaluate the effect of improvement in language function after CC7 cross transfer in stroke patients with chronic aphasia and explore its potential mechanism. Methods In a prospective observative cohort, patients diagnosed with hemiplegia combined with aphasia were included. The language function was evaluated through the changes of Aphasia Quotient evaluated by Western Aphasia Battery (WAB-AQ) as well as its four subtests from baseline to 1 week and 6 months after the surgery. Patients also received oral agility test by Boston Diagnostic Aphasia Examination (BDAE-OA). Resting-state functional MRI (rs-fMRI) was scanned before and over 6 months after the surgery to explore the potential central mechanism in language improvements. Results The average increase of WAB-AQ was 8.08 points from baseline to 1 week post-operatively (P<0.001, 95%CI: 5.05-11.10), and 9.51 from baseline to 6-month (P<0.001, 95%CI: 6.75-12.27). In 8 patients who participant in BDAE-OA, the average increase was 3.7 points (95%CI: 0.56-6.84; corrected P =0.023) from baseline to 1-week follow-up, and 5.3 points from baseline to 6 months follow-up. Significant higher local activity was detected at right precentral cortex, right gyrus rectus, and right anterior cingulate cortex after the surgery from rs-fMRI. Conclusions Immediate and stable improvement in language function was detected after CC7 cross transfer in hemiplegic patients combined with aphasia, which may be realized through enhanced function of language network in the right hemisphere.

Change of function and brain activity in patients of right spastic arm paralysis combined with aphasia after contralateral cervical seventh nerve transfer surgery

“…We identified 42 patients who presented with right spastic arm paralysis combined with aphasia. Among them, 20 patients that met the eligibility were included in this study (four more patients compared to preprint version, which was an early but partial report; Feng et al, 2023), while 22 patients were excluded due to their inability to cooperate with evaluations, having suffered from more than one stroke or traumatic brain injury since the onset of aphasia or having lesions at bilateral hemispheres.…”