Thursday, January 17, 2008

Stroke Blog

From Jose Vega M.D., Ph.D.,
Your Guide to Stroke.
Recently, someone I know whose husband became aphasic from a stroke asked me whether she would ever be able to again have a normal conversation with her husband. I knew that her husband's stroke was large, but based on that I did not feel I had enough information to make a meaningful comment about recovery. I told her, in one sentence, everything I knew about the prognosis of aphasia after stroke: "at least some partial recovery should happen by the third month after the stroke, and after that, your husband will probably continue to recover slowly over the years". Worried that she would not be able to enjoy another conversation with her husband, she then asked me how much function he would be able to recover. "Will he be able to talk to me again?"

I was at a loss. In spite of great advances in stroke neurology, little is known about the recovery of language function after stroke. Some studies have shown that some language ability can be recovered by the third month after a stroke, while other studies suggest that recovery can continue to happen gradually for many years. However, the degree of recovery a person will experience has traditionally been difficult to predict, at least in the early days after a stroke. The reason for this uncertainty is that almost anything can happen in language recovery after stroke. Some small strokes affecting language areas can cause permanent language deficits while some very large ones can induce minor, transient impairments, or no impairments at all. The only known predictor of recovery is how good a person's language function is before they suffer a stroke. Other factors like age, education, and even the size of the stroke provide no help in predicting language recovery.

For stroke doctors, knowing the potential for language recovery early after a stroke represents more than just the ability to answer the prognosis-related questions of patients and their families. Recent research shows that in the first few hours after a stroke the function of the brain undergoes some degree of reorganization by which some of the parts which are spared by the stroke appear to start working overtime, perhaps in an attempt to recover lost function . By studying these changes in the brains of patients who regain language function after stroke, scientists can identify parts of the brain which are involved in recovery, and implement therapies that enhance function in those areas.

However, before any conclusions can be reached, further research is needed to understand what these early changes in brain function after stroke mean and whether they can be used to induce recovery in the early stages after a stroke.