An update on medications and noninvasive brain stimulation to augment language rehabilitation in post-stroke aphasia

ABSTRACT

Introduction: Aphasia is among the most debilitating outcomes of stroke. Aphasia is a language disorder occurring in 10–30% of stroke survivors. Speech and Language Therapy (SLT) is the gold standard, mainstay treatment for aphasia, but gains from SLT may be incomplete. Pharmaceutical and noninvasive brain stimulation (NIBS) techniques may augment the effectiveness of SLT.

Areas covered: Herein reviewed are studies of the safety and efficacy of these adjunctive interventions for aphasia, including randomized placebo-controlled and open-label trials, as well as case series from Pubmed, using search terms ‘pharmacological,’ ‘tDCS’ or ‘TMS’ combined with ‘aphasia’ and ‘stroke.’

Expert commentary: Relatively small studies have included participants with a range of aphasia types and severities, using inconsistent interventions and outcome measures. Results to-date have provided promising, but weak to moderate evidence that medications and/or NIBS can augment the effects of SLT for improving language outcomes. We end with recommendations for future approaches to studying these interventions, with multicenter, double-blind, randomized controlled trials.

KEYWORDS:

• Aphasia
• stroke
• neuroplasticity
• catecholamines
• cholinergic
• SSRI
• noninvasive brain stimulation
• tDCS
• rTMS

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

The research reported in this paper was supported by the National Institutes of Health (National Institute of Deafness and Communication Disorders) through awards R01 DC05375 and P50 DC014664. The content is solely the responsibility of the authors and does not necessarily represent the views the National Institutes of Health.