piperidines and Aphasia

Pharmacotherapy of aphasia had been discussed for the last twenty years with first bromocriptine and amphetamine and then serotoninergic, GABAergic and cholinergic agents. Here, we reviewed the MEDLINE available reports of drug therapy for aphasia. So far, proofs of efficiency were found indubitable for none of the studied molecules. However, some of them showed limited efficiency (piracetam and amphetamine). Moreover, drug therapies for aphasia were less efficient alone than when they were associated with speech therapy.

Topics: Amphetamine; Aphasia; Bromocriptine; Cholinesterase Inhibitors; Clinical Trials as Topic; Donepezil; Dopamine Agents; Fluoxetine; GABA Agonists; Humans; Indans; Neuroprotective Agents; Paroxetine; Physostigmine; Piperidines; Piracetam; Pyridines; Selective Serotonin Reuptake Inhibitors; Serotonin; Stroke; Zolpidem

We studied 26 patients in a randomized, placebo-controlled, double-blind parallel trial to evaluate the efficacy and safety of donepezil in chronic poststroke aphasia. Donepezil (10 mg/day) improved aphasia severity at endpoint (week 16) relative to placebo (p = 0.037).

Topics: Acetylcholine; Adult; Aphasia; Brain; Cerebrovascular Circulation; Donepezil; Double-Blind Method; Female; Humans; Indans; Language Tests; Male; Middle Aged; Nerve Regeneration; Neural Pathways; Neuronal Plasticity; Nootropic Agents; Piperidines; Placebos; Recovery of Function; Speech Therapy; Stroke; Treatment Outcome

We report the case of an aborted awake craniotomy for a left frontotemporoinsular glioma due to ammonia encephalopathy on a patient taking Levetiracetam, valproic acid and clobazam. This awake mapping surgery was scheduled as a second-stage procedure following partial resection eight days earlier under general anesthesia. We planned to perform the surgery with local anesthesia and sedation with remifentanil and propofol. After removal of the bone flap all sedation was stopped and we noticed slow mentation and excessive drowsiness prompting us to stop and control the airway and proceed with general anesthesia. There were no post-operative complications but the patient continued to exhibit bradypsychia and hand tremor. His ammonia level was found to be elevated and was treated with an infusion of l-carnitine after discontinuation of the valproic acid with vast improvement. Ammonia encephalopathy should be considered in patients treated with valproic acid and mental status changes who require an awake craniotomy with patient collaboration.

Topics: Anesthesia, General; Anesthesia, Local; Anticonvulsants; Aphasia; Benzodiazepines; Brain Diseases; Brain Mapping; Brain Neoplasms; Carnitine; Clobazam; Conscious Sedation; Consciousness Disorders; Craniotomy; Dominance, Cerebral; Frontal Lobe; Glioma; Humans; Hyperammonemia; Hypnotics and Sedatives; Intraoperative Complications; Language; Levetiracetam; Male; Middle Aged; Piperidines; Piracetam; Propofol; Remifentanil; Seizures; Temporal Lobe; Valproic Acid

Topics: Adult; Aged; Aphasia; Cholinesterase Inhibitors; Chronic Disease; Donepezil; Female; Humans; Indans; Male; Middle Aged; Neuropsychological Tests; Nootropic Agents; Pilot Projects; Piperidines; Severity of Illness Index; Stroke; Treatment Outcome