PIRACETAM TREATMENT IN POSTSTROKE APHASIA

In the past, post-stroke aphasia (in common with aphasia of other orig in) has been treated mainly by means of logopaedic language therapy, i .e. language training provided by speech therapists. So-called 'suppor tive drug therapy' was not based on conclusions drawn from controlled studies. It appeared promising to complement language therapy with the administration of appropriate drugs, the efficacy of which had been d emonstrated scientifically. In animal experiments and single photon em ission tomography studies in patients with acute ischaemic stroke, pir acetam has been shown to improve microcirculation and neuronal metabol ism, and to enhance transmitter functions. Two double-blind placebo-co ntrolled studies in patients with chronic aphasia have demonstrated a beneficial effect of oral piracetam 4.8g/day preceded by intravenous b olus injection of 12g, as measured by improvement in some functionally important scores of the Aachen Aphasia Test. In a further 3 double-bl ind placebo-controlled studies in patients with acute stroke, it was s hown that improvement of aphasia was significantly greater in the grou p receiving piracetam than in the placebo group. Particular mention is made of a study (the Piracetam Acute Stroke Study) in patients with a cute stroke. These patients received placebo or intravenous piracetam 12 g/day for 5 days followed by oral piracetam 12 g/day until the end of week 4, and 4 to 8 g/day until the end of week 8. After 12 weeks of treatment, significantly more piracetam-treated patients who had init ially presented with aphasia were no longer aphasic compared with the placebo group.