Pharmacological treatment for aphasia following stroke

Drug therapy might improve recovery from loss of language function (aphasia) after stroke, but no drug has yet been proven to do more good than harm. Aphasia is a common problem after stroke. Speech and language therapy (SLT) from a speech and language therapist is the most common treatment for this disorder. A number of drugs have been used to try and improve language recovery. This review of 10 studies evaluated six different drugs. The only drug for which there was any evidence of benefit was piracetam, but the evidence of benefit was weak and there were concerns about its safety. It was not possible to conclude whether piracetam was more effective than speech and language therapy in treating aphasia after stroke. More research is needed into the effects of piracetam on aphasia, and its safety, before it can be recommended for routine use.

Authors' conclusions: 

Drug treatment with piracetam may be effective in the treatment of aphasia after stroke. Further research is needed to explore the effects of drugs for aphasia, in particular piracetam. The safety of the drug should be of primary interest. Researchers should examine the long-term effects and whether it is more effective than speech and language therapy.

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Background: 

Aphasia describes language impairment associated with a brain lesion.

Objectives: 

To assess the effects of drugs on language abilities when given to people with aphasia following stroke.

Search strategy: 

We searched the Cochrane Stroke Group Trials Register (last searched: May 2001), and reference lists of relevant articles to December 1998. We also contacted academic institutions and other researchers to identify further published and unpublished trials. MEDLINE was searched from 1966 to 1998, and CINAHL from 1982 to 1998. We handsearched the International Journal of Disorders of Communication from 1969 to 1998.

Selection criteria: 

Randomised controlled trials comparing (1) any drug given to improve language versus no treatment or versus placebo, (2) any drug given to improve language versus speech and language therapy, and (3) one drug given to improve language versus another drug given with the same aim.

Data collection and analysis: 

One reviewer collected the data, and assessed the quality of the trials with independent data checking and methodological advice. If we could not perform a statistical combination of different studies, we sought missing data. Failing that, we provided a description.

Main results: 

We included 10 trials in the review. Generally, we were unable to assess methodological quality; only one trial reported sufficient detail for analysis. Drugs used were piracetam, bifemalane, piribedil, bromocriptine, idebenone, and Dextran 40. We found weak evidence that patients were more likely to have improved on any language measure at the end of the trial if they had received treatment with piracetam (odds ratio (OR) 0.46, 95% confidence interval (CI) 0.3 to 0.7). Patients who were treated with piracetam were no more likely than those who took a placebo to experience unwanted effects, including death (OR 1.29, 95% CI 0.9 to 1.7). However, the differences in death rates between the two groups give rise to some concerns that there may be an increased risk of death from taking piracetam. We could not determine if drug treatment is more effective than speech and language therapy. We could not determine whether one drug is more effective than another.

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