Epidural electrical stimulation to improve chronic poststroke aphasia: A 5-year follow-up

摘要

Background: Aphasia is an incapacitating deficit experienced by almost 25% of patients after a left hemispheric ischemic stroke. Spontaneous recovery is considered to be limited to a period of 3 to 6 months. Although speech therapy performed during the first weeks may speed up this process and enhance its outcome, beyond this period it fails to change the global prognosis. Objective: We report a case of an unusual recovery of nonfluent chronic poststroke aphasia subsequent to extradural cortical stimulation. Methods: A right-handed woman experienced aphasia and drug-resistant central poststroke facial pain after a left superficial Sylvian ischemic stroke at the age of 58 years old. Four years after the stroke, the patient was included in a clinical trial to establish the efficiency of epidural electric stimulation on neuropathic pain. As an improvement in her language performance was noted, a speech evaluation was added to the initial protocol to quantify the benefit. Twelve months after the surgical implantation, pain and language performance were assessed in a double-blind manner during two consecutive 1-month periods when the stimulator was randomly enabled or disabled. The same evaluation was performed after 5 years of stimulation. Results: Eventually, epidural electric stimulation significantly and sustainably improved her lexical access and speech fluency. Conclusions: Cortical stimulation may offer a new approach for the treatment of late chronic poststroke aphasia.