Ten key reasons for continuing research on pharmacotherapy for post-stroke aphasia

ABSTRACT

Background: Aphasia is a devastating disorder occurring in more than 30% of stroke victims. Speech and language therapy (SLT) is the treatment of choice for post-stroke aphasia (PSA) in acute and chronic periods, yet benefits are limited and gains in several language domains are not always translated to both untreated deficits and functional communication. Therefore, pharmacotherapy and non-invasive brain stimulation (NIBS) are increasingly used to augment and accelerate gains promoted by SLT, but with different integration and use in clinical practice. Mostly owing to practical reasons, NIBS is receiving more attention and research than pharmacological interventions as adjunctive treatments for aphasia, possibly diminishing the already scarce research on drug treatment for PSA.

Aims: This review addresses ten still unsolved or unaddressed key topics for progressing in the investigation of pharmacotherapy for PSA.

Main contribution: Ten important reasons for continuing investigation in the pharmacotherapy of PSA are outlined. The use of drugs alone and combined with SLT, NIBS or both is emphasised together with recommendations for future research.

Conclusions: A small number of “proof of concept” studies have shown that pharmacotherapy provides benefits in persons with PSA. The extant evidence, though limited, suggests that modulating the activity of neurotransmitter systems with pharmacological interventions is a promising strategy for ameliorating language and communication deficits in PSA. Further research on these issues as well as on the potential role of drug treatment in non-verbal cognitive, neuropsychiatric and quality of life impairments accompanying PSA is warranted.

KEYWORDS:

• Aphasia
• cognitive enhancers
• non-invasive brain stimulation
• pharmacotherapy
• speech-language therapy
• stroke

Acknowledgment

The author thanks professor Chris Code and two anonymous reviewers for their helpful suggestions in a previous version of this manuscript.

Disclosure statement

MLB has received honoraria from Pfizer, Eisai, Janssen, Novartis, Lundbeck, TEVA and Nutricia, and consultancy fees from Merz, Eli Lilly, and GlaxoSmithKline.

Notes

1. The term “off-label” use refers to the prescription of a medical treatment (i.e., transcranial stimulation, pharmaceutical agents) for unapproved indications. Off-level prescription is a standard part of neurological practice.

2. The term compassionate refers to use of an unauthorised medicine outside a clinical trial in individual patients under strictly controlled conditions European Medicines Agency. Compassionate use.n.d.http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/general/general_content_000293.jsp&mid=WC0b01ac058007e691.

Additional information

Funding

The work was supported in part by the Ministerio de Economía, Industria y Competitividad, Instituto de Salud Carlos III, Madrid, Spain under Grant: PI16/01514.