Improvement of language function after C7 neurotomy at the intervertebral foramen in patients with chronic post-stroke aphasia: a phase I cohort study

Abstract

Background: Post-stroke aphasia is a common but intractable sequela which still needs new and more effective treatments. Evidence from follow-ups after contralateral seventh cervical nerve transfer surgery indicated that nerve transection leads to immediate language improvements in patients with right post stroke aphasia. Objective: Through a prospective cohort design, this study aims to prove that C7 neurotomy at the intervertebral foramen (NC7) combined with a 3-week intensive speech and language therapy (iSLT) can improve the language function in post-stroke aphasia patients. Methods: In this study, patients aged over 18 years old and had been diagnosed with post-stroke aphasia for 1 year or longer were included. Primary outcomes were the change in the ability to retrieve personally relevant words in Boston Naming Test (BNT) with follow-up assessment after three weeks' iSLT post operatively. As well as several secondary outcome measures including the Western Aphasia Battery (WAB), daily communication abilities (measured by the Communication Activities of Daily Living Third Edition [CADL 3]) and Fugl-Meyer of upper limb part (UEFM). Results: The average increase of BNT score was 11.2 points from baseline to 3 weeks post operatively (P=0.001, 95%CI: 8.1-14.1). The WAB and CADL-3 assessment showed 9.4, 10.4 points increasing in average (P<0.005, 95%CI: 4.6 to 14.1; P<0.001, 95%CI:6.7 to 14.1) from baseline to 4-week follow-up, respectively. The mean difference from baseline to 3 weeks post-operatively in UEFM score decreased 0.8 points (95% CI: -3.2 to 1.6; p<0.405). Conclusions: NC7 plus iSLT significantly improved the language function in patients with post-stroke aphasia, and did not significantly affect the motor function of the right limb. The mechanism of this surgery needs to be further explored.

Effect and safety of C7 neurotomy at the intervertebral foramen in patients with chronic poststroke aphasia: a multicentre, randomised, controlled study protocol

“… 46–48 Our previous investigations suggested the possible correlation between CC7 and the improvement of chronic aphasia, an effect occurring in the early postoperative period. 35 Thus, the possibility of aphasia recovery through NC7 at the intervertebral foramen caught our attention. In this study, we measured the muscle strength, joint range of motion, upper limb Modified Ashworth Scale score and sensory assessment as safety indicators to evaluate the effects of NC7 on the right side.…”

“…Based on this theoretical perspective, Xu et al originally proposed the scientific viewpoint that ‘One hemisphere controls both limbs’ and expanded the development of the ‘CC7 nerve transfer’ to ‘CC7–C7 cross nerve transfer’ for treating central hemiplegia 46–48. Our previous investigations suggested the possible correlation between CC7 and the improvement of chronic aphasia, an effect occurring in the early postoperative period 35. Thus, the possibility of aphasia recovery through NC7 at the intervertebral foramen caught our attention.…”

“…According to the literature,16 19 the naming score can be improved after intensive speech therapy and verified after non-invasive brain stimulation therapy 21 22. In the preprint data, which is a phase-I cohort study35 including patients with poststroke aphasia who received NC7 plus iSLT, the patient naming score evaluated by BNT was increased by 11.2 points on average, while that of the patients who received iSLT alone increased by 5.7 points on average from our literature review 36. According to results of our phase-I study, the SD was 6.2.…”