Cerebrolysin adjuvant treatment in Broca's aphasics following first acute ischemic stroke of the left middle cerebral artery

Abstract

Background: The aim of our study was to assess the efficacy of Cerebrolysin administration in Broca's aphasics with acute ischemic stroke.

Methods: We registered 2212 consecutive Broca's aphasics following an acute ischemic stroke admitted in four departments of neurology in Romania, between September 2005 and September 2009. Language was evaluated with the Romanian version of the Western Aphasia Battery (WAB). The following inclusion criteria were used for this study: age 20-75 years, admission in the hospital within 12 hours from the onset of the symptoms, diagnosis of first acute left middle cerebral artery (MCA) ischemic stroke, presence of large artery disease (LAD) stroke, a NIHSS score of 5-22 points, and a therapeutic time window within 72 h. Fifty two patients were treated with Cerebrolysin (Cerebrolysin group) as an adjunctive treatment. A placebo group, which received saline infusions (n=104 patients) were matched to the NIHSS and WAB scores, gender and age of the Cerebrolysin group at baseline. We assessed spontaneous speech (SS), comprehension (C), repetition (R), naming (N), and Aphasia Quotient (AQ) scores of the two groups in an open label design, over 90 days, the mRS scores and mortality.

Results: The Cerebrolysin and the placebo groups had similar age (66 +/- 8 versus 65 +/- 8 years) and sex ratio (14/38 versus 30/74). The mean AQ scores and the mean subscores for 3 subtests of WAB (SS, R, N) were similar at baseline and improved in the Cerebrolysin group significantly (p < 0.05) over placebo group at all study time points. The mRS score at 90 days was also lower in the Cerebrolysin group than in the placebo group. Cerebrolysin and placebo were both tolerated and safe, and no difference in the mortality rate was seen (3.8% in each group).

Conclusion: Cerebrolysin is effective for the treatment of Broca's aphasics with a first acute ischemic stroke of the left MCA territory.

Figure 1

Flow chart showing process of patient selection; Legend: MCA–middle cerebral artery, CT–computer tomography, MRI–magnetic resonance imaging, Doppler–Duplex carotid and vertebral Sonography, TTE–transthoracic echocardiography, LAD–large artery disease, NIHSS–National Institute of Stroke Scale, WAB–Western Aphasia Battery.

Figure 2

Time course of AQ score from day 0 to day 90 in the Cerebrolysin group and in the placebo group; Legend: AQ score=aphasia quotient score= SS score+C score+R score+N score)x2

Figure 3

Time course of SS score from day 0 to day 90 in the Cerebrolysin group and in the placebo group; Legend: SS score=spontaneous speech score= SSFC (functional content) score+SSFL (fluency) score

Figure 4

Time course of R score from day 0 to day 90 in the Cerebrolysin group and in the placebo group Legend: R score=repetition score/10 +WDFL (word fluency) score+SECO (sentence completion) score+RESP (responsive speech) score]/10

Figure 5

Time course of N score from day 0 to day 90 in the Cerebrolysin group and in the placebo group; Legend: N score=naming score=[OBNA (object naming) score

Figure 6

Absolute gain of AQ score

Figure 7

Absolute gain of SS score

Figure 8

Absolute gain of R score

Figure 9

Absolute gain of N score

Figure 10

Evolution of C scores

Figure 11

Absolute gain of C score; Legend: C score=comprehension score=[CYN (yes/no questions) scores+CWD (auditory word recognition) scores+SCO (sequential commands)score]/20

Figure 12

The evolution of language functions in the Cerebrolysin group (n=52 patients) on day 90

Figure 13

The evolution of language functions in the placebo group (n=104 patients) on day 90