title: Epidural Cortical Stimulation as Adjunctive Treatment for Nonfluent Aphasia: Phase 1 Clinical Trial Follow-up Findings.
abstract: BACKGROUND
  There is increasing interest in the application of cortical stimulation (CS) as an adjuvant strategy in aphasia rehabilitation. Epidural CS, although more invasive than other methods, can provide high-frequency ipsilesional stimulation with greater spatial specificity.
  
  
  OBJECTIVE
  We review methods and results of a phase 1 study of epidural CS in combination with rehabilitation therapy in aphasia and provide new objective and self-report data collected between 6 and 21 months after the end of treatment.
  
  
  METHODS
  Eight stroke survivors with nonfluent aphasia received intensive language therapy, 3 hours a day, for 6 weeks. Four participants also underwent surgical implantation of an epidural stimulation device that was activated only during therapy sessions. Behavioral data were collected before treatment, at the end of treatment, and at 6 and 12 weeks after the end of treatment. Of the 8 participants, 7 also participated in the longer-term follow-up visit.
  
  
  RESULTS
  Changes in objective scores from baseline were larger in investigational participants than controls at all assessments, including the longer-term follow-up visit. Satisfaction ratings and ratings of overall improvement by investigational participants and their companions were more varied than those of the controls, but all indicated that they would recommend the investigational treatment to others with aphasia.
  
  
  CONCLUSIONS
  Improvements were generally maintained for at least 12 weeks posttreatment and possibly as long as 21 months posttreatment. Epidural CS is a potentially safe, feasible adjunctive intervention for persons with chronic nonfluent aphasia that spares the ventral premotor cortex and warrants further investigation.
authors.affiliation: Center for Aphasia Research and Treatment, Rehabilitation Institute of Chicago, Chicago, IL, USA Northwestern University, Chicago, IL, USA Lcherney@ric.org.
authors.forename: Leora R
authors.initials: LR
authors.lastname: Cherney
mesh_terms: D000328:Adult; D001039:Aphasia, Broca / Q000534:rehabilitation / Q000628:therapy*; D002540:Cerebral Cortex / Q000503:physiopathology*; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007808:Language Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016037:Single-Blind Method
keywords: aphasia; brain stimulation; epidural; rehabilitation; stroke