Ten key reasons for continuing research on pharmacotherapy for post-stroke aphasia

Berthier, Marcelo L.

doi:10.1080/02687038.2020.1769987

Cited by 29 publications

(24 citation statements)

References 198 publications

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“…In chronic post-stroke Broca's aphasia, no other pharmaceutical intervention has proven its efficacy, since no randomized study has been able to demonstrate their efficiency [44]. Nevertheless, there are some trials that showed that there are some medications that have improved the results of speech therapy.…”

Section: Pharmacological Therapymentioning

confidence: 99%

“…Until now, the conclusion is that some agents may be mainly suitable for treating speech output deficits and picture naming with poor influence over comprehension, particularly in severe cases [49]. There are some theories that support the idea that selective serotonin reuptake inhibitors (SSRIs) might be useful for persons with non-fluent aphasia (e.g., Broca's aphasia), which are also associating depression and frustration, but probably they are less suitable for persons with fluent aphasia (coursing with excitement and reduced awareness) [44].…”

Section: Pharmacological Therapymentioning

confidence: 99%

“…The purpose of this study was to evaluate the efficacy of Cerebrolysin administration (30 ml Cerebrolysin mixed with 70 ml of normal saline/day/iv infusion, for 21 days) in Broca's aphasics with acute ischemic stroke (n = 156: 52 in cerebrolysin and 104 in placebo) [50]. The conclusion of this study was that spontaneous (voluntary and automatically) speech, repetition, and naming in acute Broca's aphasia have been positive influenced [44,50]. Our study clearly demonstrated that intravenous adjuvant treatment with cerebrolysin results in statistically significant and clinically important improvements of language function in patients with Broca's aphasia with a first acute ischemic stroke [50].…”

Section: Pharmacological Therapymentioning

confidence: 99%

See 2 more Smart Citations

A Comprehensive Overview of Broca’s Aphasia after Ischemic Stroke

Jianu¹,

Ilić²,

Jianu³

et al. 2022

Aphasia Compendium

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Aphasia denotes an acquired central disorder of language, which alters patient’s ability of understanding and/or producing spoken and written language. The main cause of aphasia is represented by ischemic stroke. The language disturbances are frequently combined into aphasic syndromes, contained in different vascular syndromes, which may suffer evolution/involution in the acute stage of ischemic stroke. The main determining factor of the vascular aphasia’s form is the infarct location. Broca’s aphasia is a non-fluent aphasia, comprising a wide range of symptoms (articulatory disturbances, paraphasias, agrammatism, anomia, and discrete comprehension disorders of spoken and written language) and is considered the third most common form of acute vascular aphasia, after global and Wernicke’s aphasia. It is caused by a lesion situated in the dominant cerebral hemisphere (the left one in right-handed persons), in those cortical regions vascularized by the superior division of the left middle cerebral artery (Broca’s area, the rolandic operculum, the insular cortex, subjacent white matter, centrum semiovale, the caudate nucleus head, the putamen, and the periventricular areas). The role of this chapter is to present the most important acquirements in the field of language and neurologic examination, diagnosis, and therapy of the patient with Broca’s aphasia secondary to ischemic stroke.

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Section: Pharmacological Therapymentioning

confidence: 99%

Section: Pharmacological Therapymentioning

confidence: 99%

Section: Pharmacological Therapymentioning

confidence: 99%

See 1 more Smart Citation

A Comprehensive Overview of Broca’s Aphasia after Ischemic Stroke

Jianu¹,

Ilić²,

Jianu³

et al. 2022

Aphasia Compendium

View full text Add to dashboard Cite

show abstract

“…No study has provided evidence that pharmaceutical intervention results in significant improvement in language in chronic post-stroke aphasia in the absence of SLT. 107 However, several trials have provided preliminary or inconsistent evidence that some medications may augment the effects of SLT, as reported below. A plausible mechanism is that language recovery depends on neuroplasticity-neural networks must be modified either by changing connectivity between undamaged nodes of the residual language network or by incorporating new nodes or other networks to assume the functions of the damaged ones.…”

Section: Pharmaceutical Interventions To Designed To Augment Behavioral Language Therapy For Aphasiamentioning

confidence: 99%

Current Approaches to the Treatment of Post-Stroke Aphasia

Fridriksson

Hillis

2021

J Stroke

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Aphasia, impairment of language after stroke or other neurological insult, is a common and often devastating condition that affects nearly every social activity and interaction. Behavioral speech and language therapy is the mainstay of treatment, although other interventions have been introduced to augment the effects of the behavioral therapy. In this narrative review, we discuss advances in aphasia therapy in the last 5 years and focus primarily on properly powered, randomized, controlled trials of both behavioral therapies and interventions to augment therapy for post-stroke aphasia. These trials include evaluation of behavioral therapies and computer-delivered language therapies. We also discuss outcome prediction trials as well as interventional trials that have employed noninvasive brain stimulation, or medications to augment language therapy. Supported by evidence from Phase III trials and large meta-analyses, it is now generally accepted that aphasia therapy can improve language processing for many patients. Not all patients respond similarly to aphasia therapy with the most severe patients being the least likely responders. Nevertheless, it is imperative that all patients, regardless of severity, receive aphasia management focused on direct therapy of language deficits, counseling, or both. Emerging evidence from Phase II trials suggests transcranial brain stimulation is a promising method to boost aphasia therapy outcomes.

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“…A likely explanation could be that the previous prolonged treatment with DP (duration: 26 weeks) induced long-lasting brain changes that were then profitable seized by the application of INT2 after a short washout period (4 weeks). Thus, a lesson to be learned from this finding would be that once the brain has been primed with a combined intervention (DP-INT1), it would be similarly responsive to a single modality of intervention (INT2 or a drug) applied at a later stage (see Berthier et al, 2009;Berthier, 2020).…”

Section: Combined Therapy Increases Gains Obtained With Drug Monotherapymentioning

confidence: 99%

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

et al. 2020

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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

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Ten key reasons for continuing research on pharmacotherapy for post-stroke aphasia

Cited by 29 publications

References 198 publications

A Comprehensive Overview of Broca’s Aphasia after Ischemic Stroke

A Comprehensive Overview of Broca’s Aphasia after Ischemic Stroke

Current Approaches to the Treatment of Post-Stroke Aphasia

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

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