CHU de Caen, Service de Neurochirurgie, Caen, F-14000, France.
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.
Brain Stimul. 2012 Jul;5(3):364-368. doi: 10.1016/j.brs.2011.04.003. Epub 2011 May 10.
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.
We report a case of an unusual recovery of nonfluent chronic poststroke aphasia subsequent to extradural cortical stimulation.
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.
Eventually, epidural electric stimulation significantly and sustainably improved her lexical access and speech fluency.
Cortical stimulation may offer a new approach for the treatment of late chronic poststroke aphasia.
失语症是左半球缺血性卒中后近 25%的患者出现的一种使人丧失能力的缺陷。自发恢复被认为仅限于 3 至 6 个月的时间。尽管在最初几周进行的语言治疗可能会加速这一过程并提高其效果，但在此期间之后，它无法改变整体预后。
我们报告了一例左大脑半球皮质下缺血性卒中后非流利性慢性卒中后失语症在接受皮质外刺激后出现异常恢复的病例。
一名 58 岁的右利手女性在左大脑半球浅 Sylvian 缺血性卒中后出现失语症和药物难治性中枢性卒中后面部疼痛。卒中后 4 年，该患者被纳入一项临床试验，以确定硬膜外电刺激对神经病理性疼痛的疗效。由于语言表现有所改善，因此在初始方案中增加了语言评估，以量化获益。在手术植入 12 个月后，在连续两个月的时间里，当刺激器随机开启或关闭时，以双盲方式评估疼痛和语言表现。在刺激 5 年后进行了相同的评估。
最终，硬膜外电刺激显著且可持续地改善了患者的词汇获取和言语流畅性。
皮质刺激可能为治疗晚期慢性卒中后失语症提供一种新方法。
