Contribution of using piracetam and selective serotonin reuptake inhibitörs to aphasia recovering process in patients with poststroke aphasia

Stroke is a clinical picture, following any lesion within the brain parenchyme. Stroke occurs due to various etiologies such as obsctruction of brain vessels, parenchymal hemorrhage or subarachnoidal hemorrhage. Consequently the patients suffer from various motor, sensory and cognitive function disabilities. One of the leading signs of the brain vessel disorders is aphasia. Aphasia is a cognitive function disorder following brain damage with disturbed or total loss of lingual skills. Aphasia is seen with a percentage of 21-38% during the acute phase of stroke.Aphasia is a syndrome following various ethyologies and causes a high rate of morbidity, mortality and economical loss. The identification of the type, severity and the causative agent is important for the treatment protocol, prognosis and follow-up.Various tests are used for the diagnosis of aphasia. Boston Diagnostic Aphasia Test, Western Aphasia Test , Aachen Aphasia Test and modified Gülhane Aphasia Test which is commonly used in our country are some of these tests. With these tests, spontaneous speech, understanding, reading, writing, repeating and naming functions are examined.Various methods have been experienced aiming aphasia treatment and rehabilitation up to date. Various drug therapies and speech therapies are included within these methods. For some patients, speech therapy only, for some others both speech and drug therapy have been experienced. As the medical treatment, a GABA derivative piracetam; cathecolamin system activators bromocriptin, dexamphetamine; cholinergic sstem activator donezepil and various serotonergic drugs are have been used.The efficiency of solely medical treatment on aphasic patients is not known. Whereas, speaking therapists are in limited numbers in our country and most of the patients are unable to access this therapy. By this study, with considering that aphasia is highly disturbing the daily activities of the patients, we aimed to identify the effect of solely medical therapy on aphasic patients having no speech therapy. Fort this reason we planned to test the effects of piracetam and serotonergic agents on the healing period, within the acute aphasia patients using Gülhane aphasia test and TCD.The study, after approved by the İnonü University Medical Faculty Ethics Commitee on 5.29.2007 with decision protocol number 2007/120, held in İnonü University Neurology Clinic between June 2007 and July 2008.The study included patients using right hand dominantly and suffered aphasia following left hemisphere acute ischemia or hemorrhage. Divided into 3 groups, totally 26 patients undergone piracetam and piracetam plus SSRI therapy. The group having both piracetam and SSRI therap showed a high rate of healing of aphasia scores in comparison to the other groups but no statistical significance is observed.