Brain Stimulation May Aid Stroke Recovery

Magnetic brain stimulation may help people recover speech and language after a stroke, a small study suggests. The study included 24 people who had a recent stroke. All had aphasia, difficulty with speech or language. People were randomly divided into 2 groups. One group was given transcranial magnetic stimulation. This is a low-intensity magnetic pulse. It was applied to the head on the opposite side to the area damaged in the stroke. The stimulation temporarily "shut down" brain function in that area. The purpose was to force the damaged area to work harder. Treatment lasted 20 minutes. Right afterward, people in both groups had 45 minutes of speech and language therapy. In the second group, people received sham stimulation. It was applied to a different area and did not go deep enough to stimulate the brain. This group also got speech and language therapy. After 10 days of treatment, people who got the real treatment had 3 times as much improvement in speech and language as those who got the fake treatment. The biggest improvement was seen in people's ability to name objects. The journal Stroke published the study. HealthDay News wrote about it June 27.

By Mary Pickett, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

By giving electric pulses to the top of the head, researchers in Germany have been able to help patients to have exciting improvements after stroke.

Strokes can result in a problem remembering words or recognizing words. This is called aphasia. This study looked at how to improve speaking and language recognition in patients who had aphasia.

Twenty-four patients who had aphasia from new strokes were divided into two groups. All of the people in this study had strokes on the left side of the brain. One group received electric pulses through the skull to part of the right side of the brain that is involved in language skills. The electrical impulses lasted for 20 minutes. They "shut down" the function of the working part of the brain, the side that was not injured by the stroke.

The researchers hoped that shutting down the right side would allow more practice, and more immediate recovery, by the damaged area in the left brain. Right afterward, each patient in this group had a 45-minute work session with a speech and language therapist. This was repeated for 10 days.

The second group received only very weak electrical impulses. The impulses also did not reach deeply enough to affect the language area. People in this group had the same work sessions with speech and language therapists.

The language recovery was three times greater in the group that had received the brain stimulation. This is an impressive result, even for a small study. The best recovery was seen in patients who had difficulty remembering the names of objects after their strokes. This is one of the most frustrating language problems that strokes can cause.

What Changes Can I Make Now?

This exciting technique is called non-invasive brain stimulation. It may help stroke patients to get bigger results out of therapy sessions in the first few weeks after stroke.

Experts think it will be possible to provide this therapy out of the hospital. It would be given at rehab centers where stroke patients typically receive speech therapy and physical therapy for the first weeks after a stroke.

Brain stimulation is not the only way to increase "recruitment" of the recovering brain area after a stroke. At least two other strategies can help:

• Constraint-induced movement therapy: This unusual form of physical therapy can help some people. Your fully functional arm is put in a mitt, splint or restraint for six hours or so each day. This occurs for two weeks. The technique forces you to exercise your weak hand and arm to do minor tasks. It can help you to gain the most use of the limb that has lost function. Like brain stimulation, this helps to "shut down" the opposite side of the brain. It forces your injured brain to do the hard work of re-wiring and recovering its function.
• Antidepressant medicine: Experts think this stimulates both sides of the brain. Taking an antidepressant for the first three months after a stroke does seem to be linked with better stroke recovery. Various studies have recorded improvements in problem solving, memory and attention. Better leg and arm strength also have been seen in studies. The drugs that have been studied are escitalopram (Lexapro) and fluoxetine (Prozac). These two drugs are selective serotonin reuptake inhibitors (SSRIs). It is likely that any drug of this type would have a similar effect. These drugs cause relatively few side effects.

What Can I Expect Looking to the Future?

These strategies are new in the last several years. They have not yet been made available to all stroke patients. But it is likely that all of them, including brain stimulation, will become part of standard care in the days right after a stroke.

The first six months are the most important time for recovery of function after a stroke. But physical and occupational therapy can still help in later months. Vigorous physical therapy has been shown to help some people improve even nine or more months after a stroke. A therapist can help you to become more skilled in using your other side as well.