Epidural cortical stimulation as adjunctive treatment for non-fluent aphasia: preliminary findings

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 81; no. 9; pp. 1014 - 1021
• Main Authors: Cherney, Leora R, Erickson, Robert K, Small, Steven L
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.09.2010; BMJ Publishing Group LTD
• Subjects: Adult; Aphasia - complications; Aphasia - therapy; Brain - pathology; Brain - physiology; Cerebral Cortex - physiology; Combined Modality Therapy - methods; Electric Stimulation Therapy - adverse effects; Electric Stimulation Therapy - methods; Female; Functional Laterality; Humans; Language; Language Therapy - methods; Magnetic Resonance Imaging - methods; Male; Middle Aged; Neurosciences; Psychomotor Performance - physiology; Stroke; Stroke - complications; Studies
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2009.184036

Background and purposeThis study evaluated the safety and feasibility of targeted epidural cortical stimulation delivered concurrently with intensive speech–language therapy for treatment of chronic non-fluent aphasia.MethodsEight stroke survivors with non-fluent aphasia received intensive behavioural therapy for 3 h daily for 6 weeks using a combination of articulation drills, oral reading and conversational practice. Four of these participants (investigational participants) also underwent functional MRI guided surgical implantation of an epidural stimulation device which was activated only during therapy sessions. Behavioural data were collected before treatment, immediately after treatment and at 6 and 12 weeks following termination of therapy. Imaging data were collected before and after treatment.ResultsInvestigational participants showed a mean Aphasia Quotient change of 8.0 points immediately post-therapy and at the 6 week follow-up, and 12.3 points at 12 weeks. The control group had changes of 4.6, 5.5 and 3.6 points, respectively. Similar changes were noted on subjective caregiver ratings. Functional imaging suggested increased consolidation of activity in interventional participants.ConclusionsBehavioural speech–language therapy improves non-fluent aphasia, independent of cortical stimulation. However, epidural stimulation of the ipsilesional premotor cortex may augment this effect, with the largest effects after completion of therapy. The neural mechanisms underlying these effects are manifested in the brain by decreases in the volume of activity globally and in particular regions. Although the number of participants enrolled in this trial precludes definitive conclusions, targeted epidural cortical stimulation appears safe and may be a feasible adjunctive treatment for non-fluent aphasia, particularly when the aphasia is more severe.