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Aphasia Treatment & Management

  • Author: Howard S Kirshner, MD; Chief Editor: Jasvinder Chawla, MD, MBA  more...
 
Updated: Feb 19, 2016
 

Medical Care

The treatment of a patient with aphasia depends on the cause of the aphasia syndrome. Acute stroke treatment for the aphasic patient, such as intravenous tPA, intra-arterial interventional treatments, carotid endarterectomy and stenting, or even blood pressure manipulation may help to alleviate the deficit. 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.

Speech and language therapy is the mainstay of care for patients with aphasia. The timing and nature of the interventions for aphasia vary widely. Blinded studies are limited, and recovery of some degree is the norm, but several studies have indicated that speech and language therapy does improve clinical outcomes in patients with aphasia. Patients' difficulties vary, and individualized programs are often important.

  • Psychological support is important. Many patients with aphasia have associated depression. Careful diagnosis, treatment, and emotional support are of value.
  • Special techniques exist to treat patients with articulatory problems, agrammatism, lack of syntax, and lack of intonation ability. In general, experts agree on the importance of speech therapy in aphasia. Studies have shown that intensive speech therapy may be more beneficial than a more extended course of sporadic therapy.
  • 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). SSRI antidepressants have been shown to help the emotional and behavioral problems.
  • 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.
  • New technologies are being applied to aphasia. A few early trials indicate benefit from transcranial magnetic stimulation in patients with aphasia.
  • 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.[21]
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Consultations

Consultations with a speech and language therapist and a neuropsychologist may prove helpful.

Recent studies have shown that intense treatment with a speech and language therapist, several hours per day several days a week, is more effective than a similar number of shorter sessions spread out over a longer period.

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Contributor Information and Disclosures
Author

Howard S Kirshner, MD Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center

Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Neurological Association, American Society of Neurorehabilitation, American Academy of Neurology, American Heart Association, American Medical Association, National Stroke Association, Phi Beta Kappa, Tennessee Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jasvinder Chawla, MD, MBA Chief of Neurology, Hines Veterans Affairs Hospital; Professor of Neurology, Loyola University Medical Center

Jasvinder Chawla, MD, MBA is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Clinical Neurophysiology Society, American Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Joseph Quinn, MD, MD Assistant Professor, Department of Neurology, Portland VA Medical Center, Oregon Health Sciences University

Joseph Quinn, MD, MD is a member of the following medical societies: American Academy of Neurology, Society for Neuroscience, Society for Pediatric Radiology

Disclosure: Nothing to disclose.

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