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Marcelo L. Berthier – One of the best experts on this subject based on the ideXlab platform.

  • Poststroke Aphasia
    Drugs & Aging, 2005
    Co-Authors: Marcelo L. Berthier

    Abstract:

    Aphasia, the loss or impairment of language caused by brain damage, is one of the most devastating cognitive impairments of stroke. Aphasia is present in 21–38% of acute stroke patients and is associated with high short- and long-term morbidity, mortality and expenditure. Recovery from Aphasia is possible even in severe cases. While speech-language therapy remains the mainstay treatment of Aphasia, the effectiveness of conventional therapies has not been conclusively proved. This has motivated attempts to integrate knowledge from several domains in an effort to plan more rational therapies and to introduce other therapeutic strategies, including the use of intensive language therapy and pharmacological agents. Several placebo-controlled trials suggest that piracetam is effective in recovery from Aphasia when started soon after the stroke, but its efficacy vanishes in patients with chronic Aphasia. Drugs acting on catecholamine systems (bromocriptine, dexamfetamine) have shown varying degrees of efficacy in case series, open-label studies and placebo-controlled trials. Bromocriptine is useful in acute and chronic Aphasias, but its beneficial action appears restricted to nonfluent Aphasias with reduced initiation of spontaneous verbal messages. Dexamfetamine improves language function in subacute Aphasia and the beneficial effect is maintained in the long term, but its use is restricted to highly selected samples. Pharmacological agents operating on the cholinergic system (e.g. donepezil) have shown promise. Data from single-case studies, case series and an open-label study suggest that donepezil may have beneficial effects on chronic poststroke Aphasia. Preliminary evidence suggests that donepezil is well tolerated and its efficacy is maintained in the long term. Randomised controlled trials of donepezil and other cholinergic agents in poststroke Aphasia are warranted.

  • poststroke Aphasia epidemiology pathophysiology and treatment
    Drugs & Aging, 2005
    Co-Authors: Marcelo L. Berthier

    Abstract:

    Aphasia, the loss or impairment of language caused by brain damage, is one of the most devastating cognitive impairments of stroke. Aphasia is present in 21-38% of acute stroke patients and is associated with high short- and long-term morbidity, mortality and expenditure. Recovery from Aphasia is possible even in severe cases. While speech-language therapy remains the mainstay treatment of Aphasia, the effectiveness of conventional therapies has not been conclusively proved. This has motivated attempts to integrate knowledge from several domains in an effort to plan more rational therapies and to introduce other therapeutic strategies, including the use of intensive language therapy and pharmacological agents. Several placebo-controlled trials suggest that piracetam is effective in recovery from Aphasia when started soon after the stroke, but its efficacy vanishes in patients with chronic Aphasia. Drugs acting on catecholamine systems (bromocriptine, dexamfetamine) have shown varying degrees of efficacy in case series, open-label studies and placebo-controlled trials. Bromocriptine is useful in acute and chronic Aphasias, but its beneficial action appears restricted to nonfluent Aphasias with reduced initiation of spontaneous verbal messages. Dexamfetamine improves language function in subacute Aphasia and the beneficial effect is maintained in the long term, but its use is restricted to highly selected samples. Pharmacological agents operating on the cholinergic system (e.g. donepezil) have shown promise. Data from single-case studies, case series and an open-label study suggest that donepezil may have beneficial effects on chronic poststroke Aphasia. Preliminary evidence suggests that donepezil is well tolerated and its efficacy is maintained in the long term. Randomised controlled trials of donepezil and other cholinergic agents in poststroke Aphasia are warranted.

Martin N Rossor – One of the best experts on this subject based on the ideXlab platform.

  • Primary progressive Aphasia: a clinical approach
    Journal of Neurology, 2018
    Co-Authors: Charles R. Marshall, Chris J D Hardy, Anna Volkmer, Lucy L. Russell, Rebecca L. Bond, Phillip D Fletcher, Camilla N Clark, Catherine J. Mummery, Jonathan M Schott, Martin N Rossor

    Abstract:

    The primary progressive Aphasias are a heterogeneous group of focal ‘language-led’ dementias that pose substantial challenges for diagnosis and management. Here we present a clinical approach to the progressive Aphasias, based on our experience of these disorders and directed at non-specialists. We first outline a framework for assessing language, tailored to the common presentations of progressive Aphasia. We then consider the defining features of the canonical progressive nonfluent, semantic and logopenic aphasic syndromes, including ‘clinical pearls’ that we have found diagnostically useful and neuroanatomical and other key associations of each syndrome. We review potential diagnostic pitfalls and problematic presentations not well captured by conventional classifications and propose a diagnostic ‘roadmap’. After outlining principles of management, we conclude with a prospect for future progress in these diseases, emphasising generic information processing deficits and novel pathophysiological biomarkers.

Christian Denier – One of the best experts on this subject based on the ideXlab platform.

  • Borderzone Strokes and Transcortical Aphasia
    Current Neurology and Neuroscience Reports, 2011
    Co-Authors: Cécile Cauquil-michon, C. Flamand-roze, Christian Denier

    Abstract:

    Borderzone infarcts (BZIs) are anatomically defined as ischemic lesions occurring at the junction between two arterial territories, accounting for 2% to 10% of strokes. Three types of hemispheric BZIs are described according to topography (ie, superficial anterior, posterior, and deep). Although published series on related Aphasia are rare in the setting of BZI, Aphasia is of transcortical (TCA) type, characterized by the preservation of repetition. TCA can be of motor, sensory, or mixed type depending on whether expression, understanding, or both are impaired. Recent studies have reported specific aphasic patterns. BZI patients initially presented with mixed TCA. Aphasia specifically evolved according to the stroke location, toward motor or sensory TCA in patients with respectively anterior or posterior BZI. TCA was associated with good long-term prognosis. This specific aphasic pattern is interesting in clinical practice because it prompts the suspicion of a BZI before the MRI is done, and it helps in the planning of rehabilitation and in providing adapted information to the patient and family concerning the likelihood of language recovery.

  • Aphasia in border-zone infarcts has a specific initial pattern and good long-term prognosis
    European Journal of Neurology, 2011
    Co-Authors: C. Flamand-roze, Cécile Cauquil-michon, Emmanuel Roze, Raphaëlle Souillard-scemama, Lisa Maintigneux, Denis Ducreux, David H. Adams, Christian Denier

    Abstract:

    Background:  While border-zone infarcts (BZI) account for about 10% of strokes, studies on related Aphasia are infrequent. The aim of this work was to redefine specifically their early clinical pattern and evolution.

    Methods:  We prospectively studied consecutive patients referred to our stroke unit within a 2-year period. Cases of Aphasia in right-handed patients associated with a MRI confirmed left-sided hemispheric BZI were included. These patients had a standardized language examination in the first 48 h, at discharge from stroke unit and between 6 and 18 months later.

    Results:  Eight patients were included. Three had anterior (MCA/ACA), two posterior (MCA/PCA), two both anterior and posterior, and one bilateral BZI. All our patients initially presented transcortical mixed Aphasia, characterized by comprehension and naming difficulties associated with preserved repetition. In all patients, Aphasia rapidly improved. It fully recovered within a few days in three patients. Initial improvement was marked, although incomplete in the five remaining patients: their Aphasias specifically evolved according to the stroke location toward transcortical motor Aphasia for the three patients with anterior BZI and transcortical sensory Aphasia for the two patients with posterior BZI. All patients made a full language recovery within 18 months after stroke.

    Conclusions:  We report a specific aphasic pattern associated with hemispheric BZI, including an excellent long-term outcome. These findings appear relevant to (i) clinically suspect BZI and (ii) plan rehabilitation and inform the patient and his family of likelihood of full language recovery.