doi: 10.1161/hs0901.095720
(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
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
This article has been cited by other articles:
 |
|
 |
|
  A. M. Raymer, P. Beeson, A. Holland, D. Kendall, L. M. Maher, N. Martin, L. Murray, M. Rose, C. K. Thompson, L. Turkstra, et al. Translational Research in Aphasia: From Neuroscience to Neurorehabilitation J Speech Lang Hear Res, February 1, 2008; 51(1): S259 - S275. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. E. Hillis Aphasia: Progress in the last quarter of a century Neurology, July 10, 2007; 69(2): 200 - 213. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. S. Bullain, L. S. Chriki, and T. A. Stern Aphasia: Associated Disturbances in Affect, Behavior, and Cognition in the Setting of Speech and Language Difficulties Psychosomatics, June 1, 2007; 48(3): 258 - 264. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Meintzschel and U. Ziemann Modification of Practice-dependent Plasticity in Human Motor Cortex by Neuromodulators Cereb Cortex, August 1, 2006; 16(8): 1106 - 1115. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Barrett, L. J. Buxbaum, H. B. Coslett, E. Edwards, K. M. Heilman, A. E. Hillis, W. P. Milberg, and I. H. Robertson Cognitive Rehabilitation Interventions for Neglect and Related Disorders: Moving from Bench to Bedside in Stroke Patients. J. Cogn. Neurosci., July 1, 2006; 18(7): 1223 - 1236. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Gladstone, C. J. Danells, A. Armesto, W. E. McIlroy, W. R. Staines, S. J. Graham, N. Herrmann, J. P. Szalai, S. E. Black, and for the Subacute Therapy with Amphetamine and Reha Physiotherapy Coupled With Dextroamphetamine for Rehabilitation After Hemiparetic Stroke: A Randomized, Double-Blind, Placebo-Controlled Trial Stroke, January 1, 2006; 37(1): 179 - 185. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. A. Briand, T. E. Robinson, and S. Maren Enhancement of auditory fear conditioning after housing in a complex environment is attenuated by prior treatment with amphetamine Learn. Mem., November 1, 2005; 12(6): 553 - 556. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. Duncan, R. Zorowitz, B. Bates, J. Y. Choi, J. J. Glasberg, G. D. Graham, R. C. Katz, K. Lamberty, and D. Reker Management of Adult Stroke Rehabilitation Care: A Clinical Practice Guideline Stroke, September 1, 2005; 36(9): e100 - e143. [Full Text] [PDF]
|
|
|
|
|
|
A. Chatterjee Cosmetic neurology: The controversy over enhancing movement, mentation, and mood Neurology, September 28, 2004; 63(6): 968 - 974. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-K. Lee, J.-E. Kim, M. Sivula, and S. M. Strittmatter Nogo Receptor Antagonism Promotes Stroke Recovery by Enhancing Axonal Plasticity J. Neurosci., July 7, 2004; 24(27): 6209 - 6217. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Long and J. Young Dexamphetamine treatment in stroke QJM, September 1, 2003; 96(9): 673 - 685. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L Ruhland and P. L. van Kan Medial Pontine Hemorrhagic Stroke Physical Therapy, June 1, 2003; 83(6): 552 - 566. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Marshall, T. Rundek, D. M. Sproule, B.-F. M. Fitzsimmons, S. Schwartz, and R. M. Lazar Monitoring of Cerebral Vasodilatory Capacity With Transcranial Doppler Carbon Dioxide Inhalation in Patients With Severe Carotid Artery Disease Stroke, April 1, 2003; 34(4): 945 - 949. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. K. Bhogal, R. Teasell, M. Speechley, and M. L. Albert Intensity of Aphasia Therapy, Impact on Recovery * Aphasia Therapy Works! Stroke, April 1, 2003; 34(4): 987 - 993. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Martinsson and N. G. Wahlgren Safety of Dexamphetamine in Acute Ischemic Stroke: A Randomized, Double-Blind, Controlled Dose-Escalation Trial Stroke, February 1, 2003; 34(2): 475 - 481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Gladstone, S. E. Black, and A. M. Hakim Toward Wisdom From Failure: Lessons From Neuroprotective Stroke Trials and New Therapeutic Directions Stroke, August 1, 2002; 33(8): 2123 - 2136. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Altieri, V. Di Piero, G. L. Lenzi, D. Walker-Batson, S. Curtis, and D. H. Unwin Drugs and Recovery: A Challenge for a Few? Stroke, April 1, 2002; 33(4): 1170 - 1170. [Full Text] [PDF]
|
|