Predicting recovery in acute poststroke aphasia

Abstract

Lesion load in left pSTG and SLF/AF at onset predicts later naming performance. Although based on a small number of patients, our preliminary results suggest outcome might be modulated by SSRIs, but these associations need to be confirmed in a larger randomized controlled trial. Ann Neurol 2018;83:612-622.

Predicting Early Post-stroke Aphasia Outcome From Initial Aphasia Severity

“…Most studies have investigated the prediction of language performance (for long term outcomes) such that the "size or site, " or any combination of both, could explain severity, symptoms and prognosis of aphasia (28,31,32,34,50). Conversely, we present evidence that different factors may account for the early phases of recovery, and more specifically, influence the spontaneous recovery.…”

“…Researchers have used diffusion magnetic resonance imaging (dMRI) measures to assess the influence of the lesioned AF in the language breakdown, either through the integrity of its structure (28)(29)(30) or through its properties. Other approaches include combinations of gray and white matter (31,32), or quantitative measures of the spared white matter in the contralesional hemisphere (33,34). Interestingly, some studies have found a relation between diffusion measures of different white matter fiber bundles and language outcomes in the early phases of post-stroke aphasia (35,36).…”

Aphasia Recovery: When, How and Who to Treat?

“…Aguilar and colleagues recently found that brain factors were actually more important than demographic and cognitive factors when predicting individual aphasic patients’ responses to a reading therapy, although the best predictive model included both sets of factors [ 37 ••]. Whilst not focused on treatment per se and in limited numbers, Hillis et al [ 38 ] recently demonstrated that the influence of lesion load on aphasia recovery may be influenced by SSRIs. For patients with superior temporal and/or SLF/AF lesions, the use of SSRIs improved naming outcomes, independent of the presence of depression, initial aphasia severity, or lesion volume.…”

“…Other recent findings have highlighted the important role of interactions between domain-general cognitive networks and language specific systems in therapy-induced aphasia recovery [ 41 ]. The main challenge, which is now becoming tractable, is to investigate how demographic, cognitive, and neural factors interact to determine response to therapy on a large scale [ 42 ] and how this knowledge could be applied clinically to tailor treatments [ 38 ].…”

Even when right is all that's left: There are still more options for recovery from aphasia

“…The “right‐shift hypothesis” is based on the neural redundancy theory that both hemispheres have the capacity to support speech‐motor function, although the degree to which the right hemisphere becomes involved after damage to the left may differ from person to person and/or depend upon factors that are not yet fully understood. Among the potential determinants of which route is chosen and which leads to success, size and site of left‐hemisphere lesions and lesion load of the arcuate fasciculus (AF) or other speech/language‐relevant structures, may be the most important.…”