Drug Therapy of Post-Stroke Aphasia: A Review of Current Evidence

Abstract

This review considers the role of drug therapy in the treatment of post-stroke aphasia, the evidence for efficacy of different agents, and the theory-based explanations of drug-related benefits for aphasia rehabilitation. Pharmacological interventions modulating stroke-induced disruption of diverse neurotransmitters may improve language and communication deficits in aphasic patients through facilitation of brain plasticity and long-term potentiation. However, benefits are not evident for all compounds and refinement in clinical trial designs is required. Some pharmacological trials have failed because drug treatment was not combined with speech-language therapy, while other trials combining drugs with intensive model-driven therapies also failed probably because of short-trial duration, inadequate sample selection, or lack of drug action. Preliminary data reveals that combining neuroscience-based intensive aphasia techniques (constraint-induced aphasia therapy) and drugs acting on cholinergic and glutamatergic neurotransmitter systems are associated with better outcomes than other strategies and long-term maintenance of benefits. Although further studies are needed, current state of the evidence suggests that drug therapy may play a key role in the treatment of post-stroke aphasia.

Pharmacotherapy to Enhance Cognitive and Motor Recovery Following Stroke

“…[40]. Open-label trials and RCTs using donepezil associated with speech therapy [24]. These and other findings suggest that enhancing the effects of speech therapy with donepezil may be a promising way to maximize recovery after stroke.…”

“…Dopamine agonists and levodopa have been evaluated for the treatment of post-stroke aphasia (PSA) [24]. Some of the early trials, mainly open-label trials or case studies, were conducted with bromocriptine and showed some promise.…”

“…It is well-established that acetylcholinesterase inhibitors may improve cognition in Alzheimer's disease patients. Cognitive impairment is also common after stroke and there is mounting evidence that PSA may benefit from cholinergic manipulation with acetylcholinesterase inhibitors [24]. Rivastigmine has been evaluated for the management of unilateral spatial neglect after stroke (n = 20).…”

“…Memantine is a non-competitive NMDA antagonist that is used to treat patient with Alzheimer's disease. Memantine is thought to decrease overactivation of the NMDA glutamate receptor without disruption of its physiological activity [24]. Preclinical studies have shown that short-term low-dose memantine administration significantly reduced lesion volume and improved behavioral outcomes in stroke, while higher doses may increase the size of the stroke [43].…”

Pharmacotherapy to Improve the Acquired Aphasia following Brain Damages: A Review Study

“…The recent two decades has seen accelerated developments in neuroscience research in favor of pharmacotherapy to improve the language deficits (8). Drugs in treatment of aphasia are mediators involved in activities of different neurotransmitter systems including noradrenergic (amphetamines), dopaminergic (levodopa), serotonergic (fluvoxamine), cholinergic (doenepezil) and glutamatergic (memantine) (25), which can potentially impact on the cognitive processes and is of high importance in refining attention and memory disorders (26)(27)(28)(29)(30)(31)(32)(33)(34). In general, this type of treatment strategy influences the neurotransmitters and facilitates recovery process of neural networks infrastructure of language processing (35).…”