DALLAS, Sept. 1 -- Stroke survivors who received medication along with speech therapy recovered more of the spontaneous language and syntax skills needed to hold a conversation, according to a report in this month's Stroke: Journal of the American Heart Association.
"This double-blind, placebo-controlled study is the first to link functional improvements on language tests with physical changes in brain regions that govern language," says lead researcher Josef Kessler, Ph.D., a professor at the Max-Planck-Institute for Neurological Research in Cologne, Germany.
Piracetam, the drug used in the study, has been around for 30 years and is increasingly used for people recovering from stroke. It is derived from a chemical that helps brain cells communicate, and is thought to improve learning and memory consolidation by making cell membranes more fluid and open to communicate with each other.
A stroke occurs when a blood vessel bringing oxygen and nutrients to the brain bursts or is clogged by a blood clot or other particle. Because of the rupture or blockage, part of the brain fails to get the oxygen-rich blood it needs, causing nerve cells to die within minutes. When the stroke strikes areas that govern language, one possible result is aphasia a language-processing disorder that makes it difficult for patients to communicate. Because brain tissue cannot regenerate, patients can only recover from aphasia when nearby undamaged areas take over for the damaged ones, Kessler explains.
"There has been controversy about whether medications can improve the effectiveness of speech therapy in helping stroke survivors regain functions lost due to brain damage," he says. "Although some earlier studies hinted at improvements from piracetam, those studies focused only on neuropsychological data."
In this study, researchers randomly assigned 24 patients with mild to moderate aphasia to two groups: one group received one hour of speech therapy per day, the second group received the speech therapy plus 4800 milligrams of piracetam each day. All the patients had suffered the kind of strokes caused by blocked blood vessels rather than hemorrhage.
Before treatment, both groups showed comparable performance on language tasks. After eight weeks, both groups had significant improvement in written language and comprehension. But the piracetam group showed greater improvement in semantic understanding, syntax structure (the proper ordering of words in sentences), spontaneous speech and conversational behavior.
The researchers also used brain scans to compare activity in the patients' brains during language tasks. They found that the group on piracetam showed significantly more activity than the speech therapy-only group in areas of the brain that govern specific language tasks such as: 1) language comprehension plus semantic processing, 2) language production, syntactic structure, speech control; and 3) vocalization. The speech therapy-only group showed increased activation in just the area controlling vocalization.
"We are very interested in continuing to follow our group of patients," says Kessler. "This study indicates a need for a larger investigation of piracetam in stroke."
Co-authors include A. Thiel, M.D.; H. Karbe, M.D.; and W.D. Heiss, M.D.
NR00-1167 (Stroke/Kessler )