Pharmacotherapy of Traumatic Childhood Aphasia: Beneficial Effects of Donepezil Alone and Combined With Intensive Naming Therapy

Abstract

At present, language therapy is the only available treatment for childhood aphasia (CA). Studying new interventions to augment and hasten the benefits provided by language therapy in children is strongly needed. CA frequently emerges as a consequence of traumatic brain injury and, as in the case of adults, it may be associated with dysfunctional activity of neurotransmitter systems. The use of cognitive-enhancing drugs, alone or combined with aphasia therapy, promotes improvement of language deficits in aphasic adults. In this study we report the case of a 9-year-old right-handed girl, subject P, who had chronic anomic aphasia associated with traumatic lesions in the left temporal-parietal cortex. We performed a single-subject, open-label study encompassing administration of the cholinergic agent donepezil (DP) alone during 12 weeks, followed by a combination of DP and intensive naming therapy (INT) for 2 weeks and thereafter by a continued treatment of DP alone during 12 weeks, a 4-week washout period, and another 2 weeks of INT. Four comprehensive language and neuropsychological evaluations were performed at different timepoints along the study, and multiple naming evaluations were performed after each INT in order to assess performance in treated and untreated words. Structural magnetic resonance imaging (MRI) was performed at baseline. MRI revealed two focal lesions in the left hemisphere, one large involving the posterior inferior and middle temporal gyri and another comprising the angular gyrus. Overall, baseline evaluation disclosed marked impairment in naming with mild-to-moderate compromise of spontaneous speech, repetition, and auditory comprehension. Executive and attention functions were also affected, but memory, visuoconstructive, and visuoperceptive functions were preserved. Treatment with DP alone significantly improved spontaneous speech, auditory comprehension, repetition, and picture naming, in addition to processing speed, selective, and sustained attention. Combined DP-INT further improved naming. After washout of both interventions, most of these beneficial changes remained. Importantly, DP produced no side effects and subject P attained the necessary level of language competence

Innovative Approaches to Aphasia Rehabilitation: a Review on Efficacy, Safety and Controversies

“…In three studies, Berthier et al [43,46,47] have shown a positive effect of the drug in repetition, picture-naming, and speech production with mild adverse effects (irritability, increased sexual drive, insomnia, headaches, dizziness, muscle cramps). Dávila et al [42] found an improvement in fluency, spontaneous speech, naming and phrase repetition but, in this case, no side effects were found. In this last study, in our opinion, the absence of side effects was probably due to the young age of the participant (9 years old) and the fact that the dosage of the drug was really small (5 mg/day).…”

Adjunctive Approaches to Aphasia Rehabilitation: A Review on Efficacy and Safety

“…In three studies, Berthier et al [ 43 , 46 , 47 ] have shown a positive effect of the drug in repetition, picture-naming, and speech production with mild adverse effects (irritability, increased sexual drive, insomnia, headaches, dizziness, muscle cramps). Dávila et al [ 42 ] found an improvement in fluency, spontaneous speech, naming and phrase repetition but, in this case, no side effects were found. In this last study, in our opinion, the absence of side effects was probably due to the young age of the participant (9 years old) and the fact that the dosage of the drug was really small (5 mg/day).…”

Common Neuroanatomical Substrate of Cholinergic Pathways and Language-Related Brain Regions as an Explanatory Framework for Evaluating the Efficacy of Cholinergic Pharmacotherapy in Post-Stroke Aphasia: A Review

“…In most studies researchers examined core aspects of language functions to investigate possible gains after administering donepezil. Assessment was mostly accomplished using aphasia batteries and more specifically Western Aphasia Battery (see for example: [ 36 , 117 , 118 , 119 , 120 , 122 ]). In most of them, Aphasia Battery Quotient, a measure of aphasia severity was considered as a core metric to quantify any change, while the major language domains assessed were spontaneous speech, comprehension, repetition, and naming functions.…”

“…Sparse evidence also come from studies in children. Dávila and colleagues [ 122 ] reported the case of a nine-year-old girl with word-finding difficulties, due to a severe closed TBI. A combined treatment of donepezil and intensive naming therapy had a positive effect on speech output, auditory comprehension, repetition, and picture naming, but also others cognitive functions, such as processing speed and attention.…”