Does long term use of piracetam improve speech disturbances due to ischemic cerebrovascular diseases? Levent Güngör ⇑, Murat Terzi, Musa Kazım Onar Department of Neurology, Ondokuz Mayıs University, School of Medicine, 55139 Samsun, Turkey a r t i c l e i n f o Article history: Accepted 25 November 2010 Available online 11 January 2011 Keywords: Piracetam Aphasia Cerebrovascular diseases Ischemic stroke Recovery a b s t r a c t Aphasia causes significant disability and handicap among stroke survivors. Language therapy is recommended for aphasic patients, but not always available. Piracetam, an old drug with novel properties, has been shown to have mild beneficial effects on post-stroke aphasia. In the current study, we investigated the effects of 6 months treatment with piracetam on aphasia following stroke. Thirty patients with first-ever ischemic strokes and related aphasia were enrolled in the study. The scores for the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), modified Rankin Scale (mRS), and Gülhane Aphasia Test were recorded. The patients were scheduled randomly to receive either 4.8 g piracetam daily or placebo treatment for 6 months. At the end of 24 weeks, clinical assessments and aphasia tests were repeated. The level of improvement in the clinical parameters and aphasia scores was compared between the two groups. All patients had large lesions and severe aphasia. No significant difference was observed between the piracetam and placebo groups regarding the improvements in the NIHSS, BI and mRS scores at the end of the treatment. The improvements observed in spontaneous speech, reading fluency, auditory comprehension, reading comprehension, repetition, and naming were not significantly different in the piracetam and placebo groups, the difference reached significance only for auditory comprehension in favor of piracetam at the end of the treatment. Piracetam is well-tolerated in patients with post-stroke aphasia. Piracetam taken orally in a daily dose of 4.8 g for 6 months has no clear beneficial effect on post-stroke language disorders. 2010 Elsevier Inc. All rights reserved. 1. Introduction Aphasia describes the impairment in linguistic subsystems, including semantics, phonology, or syntax, due to brain injury and most commonly stroke. In fact, 12–38% of stroke patients have aphasia (Greener, Enderby, & Whurr, 2001). Post-stroke aphasia causes devastating cognitive decline and morbidity in stroke survivors. Recovery from aphasia is accompanied by peri-lesional activation in the left hemisphere or activation of homologous areas in the right hemisphere (Weiller, 1998). Intensive speech and language therapy is the only recommended treatment for aphasia (Bhogal, Teasell, & Speechley, 2003). However, speech and language therapy is not always feasible because of the high cost of the therapy and the small number of trained speech therapists in the developing countries, where stroke is more common. Piracetam is a gamma-aminobutyric acid derivative with a potential effect on cognitive and amnestic functions (Winnicka, Tomasiak, & Bielawska, 2005). Experimental and clinical studies have suggested that piracetam has novel properties which may be beneficial for post-stroke aphasia (Greener et al., 2001). Piracetam facilitates or restores cholinergic, glutamatergic, and excitatory neurotransmission, and improves cerebral metabolism (Boissezon, Peran, Boysson, & Demonet, 2007; Kessler, Thiel, Karbe, & Heiss, 2000). When given in the acute phase of stroke, as an adjuvant to speech therapy, piracetam improves written language, naming on confrontation, and comprehension, as well as spontaneous speech, especially communicative verbal behavior, and the semantic and syntactic structure of speech (Huber, 1999; Kessler et al., 2000). The ability of cortical areas to learn from specific rehabilitative measures, such as speech therapy, might be enhanced by piracetam (Jordan & Hillis, 2006; Kessler et al., 2000). However, to date, the longest follow-up period of piracetam use in post-stroke aphasic patients is 3 months. The long-term benefits of the drug are still unknown. In the current study, we investigated the effects of piracetam on aphasia following stroke for 6 months. 2. Patients and methods 2.1. Participants The current study was conducted in the Department of Neurology of Ondokuz Mayıs University Health Practice and Research Hospital between May 2005 and December 2009. One-hundred-three 0093-934X/$ - see front matter 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.bandl.2010.11.003 ⇑ Corresponding author. Fax: +90 362 4576041. E-mail address: [email protected] (L. Güngör). Brain & Language 117 (2011) 23–27 Contents lists available at ScienceDirect Brain & Language journal homepage: elsevier/locate/b&l
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