Burton J. Tabaac, MD
Aphasia is a disorder that results from damage to portions of the brain that are responsible for language. For most people, these areas reside in the left hemisphere of the brain. Aphasia usually occurs suddenly, often following a stroke or head injury, but it may also develop slowly, as the result of a brain tumor or a progressive neurological disease. The disorder impairs the expression and understanding of language, as well as reading and writing. Aphasia may co-occur with speech disorders, such as dysarthria or apraxia of speech, which also result from brain damage.1 This Stroke article summarizes advances in clinical trials of aphasia, secondary to stroke, and the treatment studied from clinical trials over the past 5 years. The authors discuss noninvasive brain stimulation, transcranial direct current stimulation, and transcranial magnetic stimulation, as well as pharmacological and medical interventions.
Drs. Berube and Hillis noted, “methodological weaknesses in many of the aphasia treatment studies compromise strong conclusions about efficacy.” Interestingly, the authors added, “The distribution of aphasia subtypes might influence efficacy … it is possible that individuals with Broca’s aphasia respond more to certain types of treatment, while those with Wernicke’s aphasia respond more to other types. However, none of the studies have been adequately powered to identify differential efficacy across subtypes.” Drs. Berube and Hillis concluded in their review that the most effective or efficient interventions currently available combine novel Speech-Language Therapy (SLT) with noninvasive brain stimulation (NIBS) or medications.
When asked to comment further on what she thinks Blogging Stroke readers should take away from reading this topical review, Dr. Hillis said, “The most important thing to remember is that aphasia is treatable! It often continues to get better over many years.” Further research and study are needed in an effort to find efficacious and cost-effective therapies. Trials aimed at the early stage of recovery will be of great use. Navigating and deciphering which interventions have a significant effect when compared with spontaneous recovery may prove difficult, thus randomized controlled trials, and studies with larger sample sizes are sure to yield more meaningful results.
1. Aphasia. National Institute on Deafness and Other Communication Disorders (NIDCD). https://www.nidcd.nih.gov/health/aphasia. Accessed October 2019.