Electrophysiological prognostic factors of aphasia recovery
Dr Bertrand GLIZEa, Ms Marie VILLAINa, Prof Igor SIBONa, Prof Jean-Michel MAZAUXa, Prof Patrick DEHAILa, Prof Pierre-Alain JOSEPHa, Prof Dominique GUEHLa
a chu de bordeaux
Introduction: Aphasia is the main cause of communication disorders following stroke. The individual prognosis of aphasia recovery remind difficult to establish in the acute phase. The aim of this study was to investigate whether the motor evoked potentials (MEP) of the hand and the orbicularis oris in the acute phase of stroke could predict aphasia recovery.
Materials and Methods: This study is ongoing at the University Hospital of Bordeaux. All consecutive patients with aphasia, first left hemispheric stroke confirmed by imaging, right-handed, non-demented, have been proposed for inclusion. MEPs were collected after stimulation of M1 the abductor pollicis and the orbicularis oris, right and left. The assessment of language performed in the acute phase was composed of: Language Screening Test (LAST) and the aphasia severity rating scale (ASRS) of the Boston Diagnostic Aphasia Examination (BDAE). Three and six months later, the language assessment was composed by: LAST, ASRS and BDAE. Good recovery from aphasia was defined as a score of ASRS 4 or 5. The association between the presence of a MEP after stimulation and good recovery was studied by Fischer exact tests.
Results: In our interim analysis, 46 patients were followed at 3 months, and 23 at 6 months. The presence of MEP of the right hand (left cortical stimulation) was significantly associated with good recovery 3 months (p = 0.003) and 6 months (p = 0.003) after a stroke. The presence of MEP of the right orbicularis oris (left cortical stimulation) was significantly associated with good recovery 3 months (p = 0.003) and 6 months (p = 0.011).
Conclusion: MEP of hand and lips predict recovery from aphasia. This results suggest the importance of production systems in the recovery of language, suggesting a new approach compared semantic core highlighted in the old classic models such as Lichtheim.
Keywords : motor evoked potential, TMS, aphasia, prognosis, stroke