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(Stroke. 2001;32:2093.)
© 2001 American Heart Association, Inc.

Original Contributions

A Double-Blind, Placebo-Controlled Study of the Use of Amphetamine in the Treatment of Aphasia

Delaina Walker-Batson, PhD; Sandra Curtis, MA; Rajeshwari Natarajan, PhD; Jean Ford, PhD; Nina Dronkers, PhD; Eva Salmeron, MD; Jenny Lai, MD D. Hal Unwin, MD

From The Stroke Center-Dallas, Department of Communication Sciences & Disorders, Texas Woman’s University (D.W.-B., S.C., J.F.), The Mobility Foundation Center and Department of Neurology, University of Texas Southwestern Medical Center (D.W.-B., D.H.U.), and the Department of Statistical Science, Southern Methodist University (R.N.), Dallas, Tex; the Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston (E.S., J.L.); and Center for Aphasia and Related Disorders, VA Northern California Health Care System (N.D.), Martinez, Calif.

Correspondence and reprint requests to Dr Delaina Walker-Batson, The Stroke Center-Dallas, Department of Communication Sciences & Disorders, Texas Woman’s University, 1810 Inwood Road, Dallas, TX 75235-7299.E-mail DWalkerBatson{at}twu.edu

Background and Purpose—— A number of studies suggest that drugs which increase the release of norepinephrine promote recovery when administered late (days to weeks) after brain injury in animals. A small number of clinical studies have investigated the effects of the noradrenergic agonist dextroamphetamine in patients recovering from motor deficits following stroke. To determine whether these findings extend to communication deficits subsequent to stroke, we administered dextroamphetamine, paired with speech/language therapy, to patients with aphasia.

Methods—— In a prospective, double-blind study, 21 aphasic patients with an acute nonhemorrhagic infarction were randomly assigned to receive either 10 mg dextroamphetamine or a placebo. Patients were entered between days 16 and 45 after onset and were treated on a 3-day/4-day schedule for 10 sessions. Thirty minutes after drug/placebo administration, subjects received a 1-hour session of speech/language therapy. The Porch Index of Communicative Ability was used at baseline, at 1 week off the drug, and at 6 months after onset as the dependent language measure.

Results—— Although there were no differences between the drug and placebo groups before treatment (P=0.807), by 1 week after the 10 drug treatments ended there was a significant difference in gain scores between the groups (P=0.0153), with the greater gain in the dextroamphetamine group. The difference was still significant when corrected for initial aphasia severity and age. At the 6-month follow-up, the difference in gain scores between the groups had increased; however, the difference was not significant (P=0.0482) after correction for multiple comparisons.

Conclusions—— Administration of dextroamphetamine paired with 10 1-hour sessions of speech/language therapy facilitated recovery from aphasia in a small group of patients in the subacute period after stroke. Neuromodulation with dextroamphetamine, and perhaps other drugs that increase central nervous system noradrenaline levels, may facilitate recovery when paired with focused behavioral treatment.

Editorial Comment

Dennis M. Feeney, PhD; Guest Editor

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