Atomoxetine administration combined with intensive speech therapy for post-stroke aphasia: evaluation by a novel SPECT method.
OBJECTIVE
We clarified the safety, feasibility, and efficacy of atomoxetine administration combined with intensive speech therapy (ST) for patients with post-stroke aphasia. In addition, we investigated the effect of atomoxetine treatment on neural activity of surrounding lesioned brain areas.


METHODS
Four adult patients with motor-dominant aphasia and a history of left hemispheric stroke were studied. We have registered on the clinical trials database (ID: JMA-IIA00215). Daily atomoxetine administration of 40 mg was initiated two weeks before admission and raised to 80 mg 1 week before admission. During the subsequent 13-day hospitalization, administration of atomoxetine was raised to 120 mg and daily intensive ST (120 min/day, one-on-one training) was provided. Language function was assessed using the Japanese version of The Western Aphasia Battery (WAB) and the Token test two weeks prior to admission, on the day of admission, and at discharge. At two weeks prior to admission and at discharge, each patient's cortical blood flow was measured using (123)I-IMP-single photon emission computed tomography (SPECT).


RESULTS
This protocol was successfully completed by all patients without any adverse effects. Four patients showed improved language function with the median of the Token Test increasing from 141 to 149, and the repetition score of WAB increasing from 88 to 99. In addition, cortical blood flow surrounding lesioned brain areas was found to increase following intervention in all patients.


CONCLUSIONS
Atomoxetine administration and intensive ST were safe and feasible for post-stroke aphasia, suggesting their potential usefulness in the treatment of this patient population.
a Department of Rehabilitation Medicine , The Jikei University School of Medicine , Tokyo , Japan.
Naoki
N
Yamada
a Department of Rehabilitation Medicine , The Jikei University School of Medicine , Tokyo , Japan.
Wataru
W
Kakuda
a Department of Rehabilitation Medicine , The Jikei University School of Medicine , Tokyo , Japan.
Kazuma
K
Yamamoto
a Department of Rehabilitation Medicine , The Jikei University School of Medicine , Tokyo , Japan.
Ryo
R
Momosaki
a Department of Rehabilitation Medicine , The Jikei University School of Medicine , Tokyo , Japan.
Masahiro
M
Abo
D018759:Adrenergic Uptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D000368:Aged; D001037:Aphasia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D000069445:Atomoxetine Hydrochloride / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D013070:Speech Therapy / Q000379:methods*; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D018759:Adrenergic Uptake Inhibitors; D000069445:Atomoxetine Hydrochloride
brain plasticity; selective noradrenaline reuptake inhibitor; single photon emission computed tomography; speech rehabilitation; stroke