The role of pharmacotherapy in aphasia treatment has been investigated by scientists for over six decades. Although pharmacotherapy is widely viewed to hold clinical promise, the National Institute on Deafness and Other Communicative Disorders website currently characterizes it as "a new, experimental approach to treating aphasia." Progress has been slow, clearly. Aphasia pharmacotherapy is an intrinsically complex domain to investigate, further complicated clinically by drugs prescribed for medical needs unrelated to aphasia rehabilitation. Among key lessons learned from research to date are:
- Aphasia pharmacotherapy presents fundamental challenges, since drugs operate at systemic levels and cannot narrowly target speech, language, or communication behaviors. They also may have undesirable side effects. Some drugsfor example, the stimulants amphetamine and bromocriptine, and the cognition booster piracetamare considered candidates to deliver speech-language benefits. Other drugs, including many common anti-seizure medications, anti-hypertensives, and tranquilizers, show no speech-language benefits. Finally, some drugsthe anti-hypertensive Clonidine, and the anti-seizure medication Phenytoinappear to impede recovery from aphasia.
- Benefits have been documented only when pharmacological regimens are accompanied by courses of speech-language therapy. Drugs alone, without behavioral therapy, do not improve speech-language recovery. This phenomenon has parallels elsewhere in rehabilitation: studies of motor recovery show drugs improve outcomes only when combined with concurrent courses of physical therapy.
- Important questions remain: Is ongoing drug administration required to maintain the additional improvements, or does it only accelerate the rate of progress? If ultimate outcomes are improved, does maintenance of the additional improvements require ongoing drug administration?
Results from a double-blind, placebo-controlled study published in 2001 illustrate a mix of findings. Data analysis shows that in the first several weeks following stroke, persons with aphasia receiving speech-language therapy coupled with dextroamphetamine improved significantly more than comparable patients who received only the speech-language therapy. Assessment six months later showed that both groups continued to improve: the treatment group's mean advantage had grown in magnitude, but in the final analysis their advantage was no longer statistically significant. Given the unresolved questions, clinical recommendations on the use of pharmaceuticals in aphasia rehabilitation have remained conservative. In 2004, neurologist Steven Small of the University of Chicago critically reviewed available evidence and concluded: (1) both behavioral therapy and pharmacotherapy have the potential to help restore cerebral function; (2) pharmacotherapy for aphasiawhile not provenholds promise when combined with behavioral therapy; and (3) particular drugs shown to impede aphasia recovery should be avoided, while anti-depressants should be given to those with aphasia who are depressive following stroke.
This article is part of Lingraphica's "Topics in Aphasia" series, and was written by Lingraphica's Chief Scientist, Richard Steele, Ph.D. Dr. Steele is responsible for the Lingraphica treatment technology as well as for the research on its effectiveness. He graduated with a BS in Physics from Stanford University and an MA and Ph.D. in Slavic Languages and Linguistics from Harvard University.
For Further Reading and Information
Small, S. (2004). A biological model of aphasia rehabilitation: Pharmacological perspectives. Aphasiology, 18(5/6/7), 473-492
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