Epidural electrical stimulation to improve chronic poststroke aphasia: a 5-year follow-up.
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.
CHU de Caen, Service de Neurochirurgie, Caen, F-14000, France. Electronic address: anne.balossier@free.fr.
Anne
A
Balossier
CHU de Caen, Laboratoire d'Explorations Fonctionnelles du Système Nerveux, Caen, F-14000, France; Université de Caen Basse-Normandie, UFR de Médecine, Caen, F-14000, France.
Olivier
O
Etard
CHU de Caen, Service de Neurologie, Caen, F-14000, France.
Chloé
C
Descat
INSERM, INSERM U919, Serine Proteases and Pathophysiology of the Neurovascular Unit, Université de Caen Basse-Normandie, GIP Cyceron, Caen, F-14073, France.
Denis
D
Vivien
CHU de Caen, Service de Neurochirurgie, Caen, F-14000, France; Université de Caen Basse-Normandie, UFR de Médecine, Caen, F-14000, France; INSERM, INSERM U919, Serine Proteases and Pathophysiology of the Neurovascular Unit, Université de Caen Basse-Normandie, GIP Cyceron, Caen, F-14073, France.
Evelyne
E
Emery
D001037:Aphasia / Q000209:etiology* / Q000534:rehabilitation*; D004599:Electric Stimulation Therapy / Q000379:methods*; D004824:Epidural Space; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome