A double-blind, placebo-controlled study of the use of amphetamine in the treatment of aphasia
A double-blind, placebo-controlled study of the use of amphetamine in the treatment of aphasia
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DOI：
10.1161/hs0901.095720
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发表时间：
2001-09-01
期刊：
影响因子：
8.3
通讯作者：
Unwin, DH
中科院分区：
文献类型：
--
作者：
Walker-Batson, D;Curtis, S;Unwin, DH
背景和目的：许多研究表明，在动物脑损伤后（数天至数周）给药时，增加去甲肾上腺素释放的药物可促进恢复。少量临床研究调查了去甲肾上腺素能激动剂右旋安非他明对中风后运动缺陷患者康复的影响。为了确定这些发现是否适用于中风后的交流缺陷，我们对失语症患者给予右旋安非他明和言语/语言治疗。方法：在一项前瞻性双盲研究中，21例急性非出血性梗死失语患者被随机分配接受10mg右旋安非他明或安慰剂治疗。患者在发病后第16天至45天之间入院，按照3天/4天的治疗计划进行10次治疗。服用药物/安慰剂30分钟后，受试者接受1小时的言语/语言治疗。在基线、停药1周和发病后6个月使用交际能力的Porch指数作为依赖语言测量。结果：治疗前药物组与安慰剂组无显著性差异（P = 0.807），但10次药物治疗结束后1周，两组间的增益评分有显著性差异（P = 0.0153），以右旋安非他明组增益较大。在对初始失语严重程度和年龄进行校正后，差异仍然显著。在6个月的随访中，两组之间的增重得分差异有所增加；但经多重比较校正后，差异无统计学意义（P = 0.0482）。结论：一小部分脑卒中亚急性期失语症患者给予右旋安非他明配合10个1小时的言语/语言治疗，有助于失语症的恢复。右旋安非他明的神经调节，或者其他增加中枢神经系统去甲肾上腺素水平的药物，如果配合集中的行为治疗，可能会促进康复。
Background and Purpose-A number of studies suggest that drugs which increase the release of norepinephrine promote recovery when administered late (days to weeks) after brain injury in animals. A small number of clinical studies have investigated the effects of the noradrenergic agonist dextroamphetamine in patients recovering from motor deficits following stroke. To determine whether these findings extend to communication deficits subsequent to stroke, we administered dextroamphetamine, paired with speech/language therapy, to patients with aphasia.Methods-In a prospective, double-blind study, 21 aphasic patients with an acute nonhemorrhagic infarction were randomly assigned to receive either 10 mg dextroamphetamine or a placebo. Patients were entered between days 16 and 45 after onset and were treated on a 3-day/4-day schedule for 10 sessions. Thirty minutes after drug/placebo administration, subjects received a 1-hour session of speech/language therapy. The Porch Index of Communicative Ability was used at baseline, at 1 week off the drug, and at 6 months after onset as the dependent language measure.Results-Although there were no differences between the drug and placebo groups before treatment (P = 0.807), by 1 week after the 10 drug treatments ended there was a significant difference in gain scores between the groups (P = 0.0153), with the greater gain in the dextroamphetamine group. The difference was still significant when corrected for initial aphasia severity and age. At the 6-month follow-up, the difference in gain scores between the groups had increased; however, the difference was not significant (P = 0.0482) after correction for multiple comparisons.Conclusions-Administration of dextroamphetamine paired with 10 1-hour sessions of speech/language therapy facilitated recovery from aphasia in a small group of patients in the subacute period after stroke. Neuromodulation with dextroamphetamine, and perhaps other drugs that increase central nervous system noradrenaline levels, may facilitate recovery when paired with focused behavioral treatment.