Developments in treating the nonmotor symptoms of stroke

ABSTRACT

Introduction

Stroke is among the most common causes of disability worldwide. Nonmotor symptoms of stroke are common and disabling. Many are treatable, and intervention improves the quality of life for stroke survivors.

Areas covered

Here the author summarizes the evidence-based treatment of depression and other mood disorders, aphasia, hemispatial neglect, impairments of emotional communication and empathy, deficits in memory and other cognitive functions, sleep disorders, pain, fatigue, and seizures resulting from stroke. The author focuses on treatments supported by randomized controlled trials (RCTs), from the literature cited in Google Scholar, Embase, and Pubmed.

Expert opinion

While behavioral rehabilitation is the most common intervention for many of the sequelae of stroke, relatively small RCTs support the use of noninvasive brain stimulation (transcranial direct current stimulation and transcranial direct current stimulation) and medications that facilitate neural plasticity and recovery. These noninvasive brain stimulation methods remain investigational for post-stroke symptoms. The strongest evidence for pharmacological intervention is in the domains of post-stroke mood disorders and epilepsy, but additional RCTs are needed to confirm the efficacy of selective serotonin reuptake inhibitors and other medications for improving recovery of cognition, language, and energy after stroke.

KEYWORDS:

• Stroke
• cognitive impairment
• depression
• fatigue
• aphasia
• rehabilitation
• medication
• transcranial direct current stimulation

Article highlights

• Non-motor symptoms of stroke, including mood disorders, aphasia, hemispatial neglect, disorders of emotional communication, fatigue, seizures, sleep disorders, and pain, are common and disabling sequelae.

• Pharmacological interventions have been shown to be effective, through randomized clinical trials, for many post-stroke mood disorders, including depression and seizures, but are variably effective in treating post-stroke fatigue, sleep disorders, and pain.

• Rehabilitation, including physical and occupational therapy, is the primary intervention for hemispatial neglect and pain due to spasticity, but behavioral therapies might be augmented by non-invasive brain stimulation (or medications for spasticity).

• Speech-language treatment is the most important approach for treating aphasia and emotional communication deficits, but speech-language therapies might be augmented by non-invasive brain stimulation or medications.

• Sleep apnea is most effectively treated with Continuous Positive Airway Pressure (CPAP), although tolerance and compliance are limited (40–70%); alternative approaches should be tried when CPAP is not tolerated, due to the negative consequences of sleep apnea on outcome and stroke recurrence.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the National Institutes of Health (NIDCD) through [R01 DC05375, R01 DC015466, and P50014664].