Workshop on Pharmacology of hearing and speech sciences

1. APHASIA
DR. GHULAM SAQULAIN
M.B.B.S., D.L.O., F.C.P.S
HEAD OF DEPARTMENT OF ENT
CAPITAL HOSPITAL,
ISLAMABAD

2. Definition:
 Aphasia is an acquired disorder of language
due to brain damage.

3.  Aphasia develops abruptly in patients with a
stroke or head injury. Patients with
neurodegenerative diseases or mass lesions
may develop aphasia insidiously.

4. Treatment:
 The treatment of a patient with aphasia
depends on the cause.
 Acute stroke treatment for the aphasic patient
 Surgery for a subdural hematoma or brain tumor
may be beneficial.
 In infections such as herpes simplex encephalitis,
antiviral therapy may help the patient recover.

5.  Speech and language therapy is the
mainstay of care for patients with aphasia.
 The timing and nature of the interventions for
aphasia vary widely.

6.  Medical treatment of aphasia is considered
experimental:
 dopaminergic, cholinergic, and stimulant drugs
have been tried, but no clear benefit has been
shown in large trials.
 In primary progressive aphasia, the drugs used
for Alzheimer disease have not been proven
beneficial (and a cholinergic deficiency is not
evident as in Alzheimer disease).
 Antidepressants have been shown to help the
emotional and behavioral problems.

7.  Small-scale clinical trials of treatments for
aphasia have been reported. These suggest
benefit, comparing reasonably well with
evidence-based therapies for neurologic
diseases involving drugs. Of great interest is
whether the combination of medical therapy
and speech therapy is of greater benefit than
that of speech therapy alone.

8.  In a double-blind, placebo-controlled,
parallel-group study, Berthier et al observed
the effect of memantine and constraint-
induced aphasia therapy(CIAT) on chronic
poststroke aphasia. Memantine and CIAT
alone improved aphasia compared with
placebo, but the best outcomes were
observed when memantine and CIAT were
combined. Beneficial effects continued with
long-term follow-up.

9. Pharmacotherapy
 Drugs investigated in RCTs
 Piracetam
 Weak evidence in support but concern for side effects
 Dextran – insufficient evidence
 Bifemelane - insufficient evidence
 Bromocriptine - insufficient evidence
 Idebenone - insufficient evidence
 Piribedil - insufficient evidence
Greener, Enderby & Whurr, 2010

10.  Additional studies of drugs therapy in aphasia
 Piracetam – strong, positive evidence in favor (n=5)
 Bromocriptine – strong evidence against (n=4)
 Levodopa – moderate evidence in favor (n=1)
 Amphetamines – moderate evidence in favor (n=2)
 Bifemelane – insufficient evidence (n=1)
 Dextran – moderate evidence against (n=1)
 Moclobemide – insufficient evidence (n=1)
 Donepizil – moderate evidence in favor during active
treatment (n=2)
 Memantine – moderate evidence in favor with CILT (n=1)
Salter, Teasell, Bhogal, Zettler & Foley, 2010

11. Drugs Causing Aphasia
 Benzodiazepines
 No permanent neruotoxicity
 A jargon aphasia rarely reported
 Possible cause may be interaction between partial seizures
and clobazam.
 Metrizamide
 Aphasia has been reported with metrizamide myelography
 Onset of symptoms 1-18 hours
 Duration of aphasia is typically brief ie., 36 hours.
 Neurotoxic effect