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Aphasia outcome: the interactions between initial severity, lesion size and location

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Abstract

Objectives

The outcome of aphasia at 3 months is variable in patients with moderate/severe stroke. The aim was to predict 3-month aphasia outcome using prediction models including initial severity in addition to the interaction between lesion size and location at the acute phase.

Methods

Patients with post-stroke aphasia (assessed by the Aphasia Rapid Test at day 7-ART D7) and MRI performed at day 1 were enrolled (n = 73). Good outcome at 3-months was defined by an Aphasia Handicap Score of 0–2. Each infarct lesion was overlapped with an area of interest in the left temporo-parietal region to compute an intersection index (proportion of the critical region damaged by the infarct). We tested ART D7, age, lesion volume, and intersection index as well as a combined variable lesion volume*intersection in a univariate analysis. Then, we performed a multivariate analysis to investigate which variables were independent predictors of good outcome.

Results

ART at D7, infarct volume, and the intersection index were univariate predictors of good outcome. In the multivariate analysis, ART D7 and “volume ≥ 50 ml or intersection index ≥ 20%” correctly classified 89% of the patients (p < 0.0001). When added to the model, the interaction between both variables was significant indicating that the impact of the size or site variable depends on the initial severity of aphasia.

Conclusion

In patients with initially severe aphasia, large infarct size or critical damage in left temporoparietal junction is associated with poor language outcome at 3 months.

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Acknowledgements

The Pitié-Salpêtrière registry was supported by the French Ministry of Health grant EVALUSINV PHRC AOM 03 008. The research leading to these results has received funding from “Investissements d’avenir” ANR-10-IAIHU-06.

Funding

No grant was provided for this analysis and this study.

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Authors and Affiliations

  1. APHP-Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, 83 Boulevard de l’Hôpital, 75013, Paris, France

    Sarah Benghanem, Charlotte Rosso, Céline Arbizu, Anne Leger, Christine Pires & Yves Samson

  2. Inserm U 1127, CNRS UMR 7225, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France

    Charlotte Rosso, Eric Moulton, Didier Dormont & Yves Samson

  3. IM2A, Hôpital Pitié-Salpêtrière, Paris, France

    Céline Arbizu

  4. APHP-Neuroradiology Department, Hôpital Pitié-Salpêtrière, 75013, Paris, France

    Didier Dormont

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  1. Sarah Benghanem
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  2. Charlotte Rosso
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  3. Céline Arbizu
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  4. Eric Moulton
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Corresponding author

Correspondence to Yves Samson.

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Patient consent and ethics

The Pitié-Salpêtrière registry has approval by an ethics committee (Paris VI ethic committee). However and in accordance with French legislation, written informed consent from patients was waived, as it is a retrospective database implying only analysis of anonymized data collected prospectively as part of routine clinical care.

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Benghanem, S., Rosso, C., Arbizu, C. et al. Aphasia outcome: the interactions between initial severity, lesion size and location. J Neurol 266, 1303–1309 (2019). https://doi.org/10.1007/s00415-019-09259-3

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  • DOI: https://doi.org/10.1007/s00415-019-09259-3

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