Transient prosopagnosia after ischemic stroke

Abstract

Abstract-The authors assessed the efficacy of bromocriptine in nonfluent aphasia after stroke in a 16-week, randomized, double-blind, placebo-controlled clinical trial conducted from June 2002 to April 2004. In all 38 patients after 4 months of treatment, improvement in both the bromocriptine and placebo treatment groups was observed (p Ͻ 0.001). The analysis of repeated-measures analysis of variance revealed bromocriptine did not improve nonfluent aphasia. NEUROLOGY 2006;66:914-916 F. Ashtary, MD; M. Janghorbani, PhD; A. Chitsaz, MD; M. Reisi, MD; and A. Bahrami, BS Bromocriptine mesylate, an ergot derivative, is a sympatholytic dopamine D 2 receptor agonist that exerts inhibitory effects on serotonin turnover in the CNS. In partial lesions, such as those associated with nonfluent aphasia, postsynaptic dopaminergic agents, such as bromocriptine, could improve frontal lobe function. However, the effect of bromocriptine on nonfluent aphasia in stroke patients is not clear. [1][2][3][4][5][6][7][8][9] Some trials showed no effect 1,2,4 and others showed a positive effect, 3,5-9 but these studies were mostly small openlabel studies. Therefore, we conducted a large doubleblind study to determine whether bromocriptine can be used in the clinical setting for the management of nonfluent aphasia after stroke.Methods. Thirty-eight nonfluent aphasic stroke patients in an acute phase were recruited from the neurology emergency department of Isfahan University of Medical Sciences Hospitals, Isfahan, Iran, between June 2002 and April 2004. Entry criteria included age 80 years and younger, right-handedness, Persian speaking, and availability for follow-up for 4 months. All patients had no evidence of cardiac, hepatic, renal, or other chronic or neuropsychiatric disorder, as determined by history, physical examination, and screening laboratory tests. Neurologic examination, language assessment, routine blood tests, EKG, and brain CT or MRI were performed before study entry. The nature of the trial was explained to the patient or their first-degree relatives and his or her written consent obtained. Tenets of current version of the Declaration of Helsinki were followed, and institutional ethical committee approval was granted.The 38 participants were assigned randomly and equally to one of the two treatment groups by flipping a coin at the time of study entry. The first treatment group received bromocriptine in a 2.5-mg/day increment over 4 weeks to 10 mg/day for a total of 4 months. The second group received a placebo. The placebo was identical in appearance and packaging to the active drug. The dose of bromocriptine or matching placebo remained constant during the following 16 weeks of the study. All patients tolerated the dose-escalation protocol without major side effects. Therefore, no participants were excluded from the study.The trial was double blinded in that both patient and speech therapist were not aware of treatment type that the patient was received. Patients were evaluated at 0, 8, and 16 weeks after the start ...

Face processing improvements in prosopagnosia: successes and failures over the last 50 years

“…Because no neuroimaging data is presented, unfortunately it is difficult to know if this recovery was due to healing of the peripheral vasculature and support structures (e.g., reduced inflammation) or reorganization of the brain. Lang et al (2006) provide more convincing evidence of neural reorganization, reporting full recovery after 6 months in an 89 year-old prosopagnosic woman with damage to right occipital-temporal regions. Interestingly, a post-recovery functional MRI revealed exclusive activation of the left fusiform face area (FFA) rather than the more typical right FFA activation when viewing faces, suggesting possible reorganization of face processing to homologous regions in the left hemisphere.…”

“…This redundancy would go along with findings that unilateral lesions are typically associated with less pronounced deficits than bilateral lesions (unilateral: Barton, 2008; in contrast, bilateral: Rossion et al, 2003) and why more APs recover after unilateral lesions than bilateral lesions. Furthermore, some redundancy amongst homologous areas can help explain Lang et al's (2006) demonstration of complete recovery as well as engagement of the left FFA after damage to right occipital-temporal regions. Despite some redundancy, homologous regions might have somewhat different functional properties.…”

“…Considering the positive results of the patients with unilateral lesions (Glowic and Violon, 1981; Hier et al, 1983; Lang et al, 2006) along with the lack of recovery in patients with bilateral occipital-temporal damage (Ogden, 1993; Spillmann et al, 2000), it seems that unilateral lesions may have the best prognosis for recovery. Bilateral lesions likely damage homologous core face processing regions such as the occipital face area (OFA), FFA and the posterior temporal sulcus (pSTS) (Haxby et al, 2001), which may destroy key nodes in the face processing network (see more on this below).…”

The rehabilitation of face recognition impairments: a critical review and future directions

“…There have been some instances of recovery of prosopagnosia in adults in the absence of any formal attempts at rehabilitation (e.g., Malone et al, 1982; Lang et al, 2006), but this is by no means consistent: many other cases have found no evidence of improvement or recovery over time (e.g., Sparr et al, 1991; Ogden, 1993; Spillmann et al, 2000). However, work examining the effects of peri- or prenatal injuries on the development of face recognition skills suggests that the infant system may be more plastic following damage than the adult system.…”

“…When looking at instances of spontaneous recovery from AP, there is some indication that this occurred following unilateral (Glowic and Violon, 1981; Lang et al, 2006) rather than bilateral (Sparr et al, 1991; Ogden, 1993) damage. When it comes to formal interventions (summarized in Table 1) two of the three AP studies that have reported some success involve patients with unilateral damage (i.e., Polster and Rapcsak, 1996; Francis et al, 2002); the other study reporting improvement involved a patient with bilateral damage that did not consistently affect the same areas of the brain (Powell et al, 2008).…”