Piracetam Treatment in Post-Stroke Aphasia

Summary

In the past, post-stroke aphasia (in common with aphasia of other origin) has been treated mainly by means of logopaedic language therapy, i.e. language training provided by speech therapists. So-called ‘supportive drug therapy’ was not based on conclusions drawn from controlled studies. It appeared promising to complement language therapy with the administration of appropriate drugs, the efficacy of which had been demonstrated scientifically. In animal experiments and single photon emission tomography studies in patients with acute ischaemic stroke, piracetam has been shown to improve microcirculation and neuronal metabolism, and to enhance transmitter functions.

Two double-blind placebo-controlled studies in patients with chronic aphasia have demonstrated a beneficial effect of oral piracetam 4.8 g/day preceded by intravenous bolus injection of 12g, as measured by improvement in some functionally important scores of the Aachen Aphasia Test. In a further 3 double-blind placebo-controlled studies in patients with acute stroke, it was shown that improvement of aphasia was significantly greater in the group receiving piracetam than in the placebo group. Particular mention is made of a study (the Piracetam Acute Stroke Study) in patients with acute stroke. These patients received placebo or intravenous piracetam 12 g/day for 5 days followed by oral piracetam 12 g/day until the end of week 4, and 4 to 8 g/day until the end of week 8. After 12 weeks of treatment, significantly more piracetam-treated patients who had initially presented with aphasia were no longer aphasia compared with the placebo group.