No effects of anodal transcranial direct stimulation on language abilities in early rehabilitation of post-stroke aphasic patients.

BACKGROUND AND PURPOSE: Recent research suggests that an increased level of stroke-affected left hemisphere cortical (especially frontal) excitability is associated with better language improvement in aphasic patients. Anodal transcranial direct current stimulation (A-tDCS), increasing cortical activity, may facilitate perilesional left hemisphere recruitment to subserve language processing and enhance effects of behavioural therapy. The aim of the study (randomized, double-blind, sham-controlled) was to evaluate the effectiveness of repeated A-tDCS over Broca area as a strategy to enhance aphasia recovery during early post-stroke rehabilitation. MATERIAL AND METHODS: Thirty-seven participants with moderate or severe aphasia were randomized to receive 15 consecutive daily sessions of A-tDCS (1 mA, 10 min; experimental group, n = 18) or sham stimulation (1 mA, 25 s; control group, n = 19) followed by language therapy. Effects of tDCS were assessed using the Boston Diagnostic Aphasia Examination, performed before and after the rehabilitation, and three months later. RESULTS: The results did not confirm a positive impact of repeated A-tDCS, preceding language therapy, on language abilities in our patients. Although both groups improved after the therapy, there were no statistically significant differences between groups in either short-term or long-term tDCS effects. Effect sizes for the experimental group, at post-treatment and the 3-month follow-up, were slightly higher than in controls but insufficient to infer any beneficial influence of the applied intervention. CONCLUSIONS: The findings do not support A-tDCS functional benefits during early rehabilitation of post-stroke aphasia. Further research is needed to explore the effectiveness of this kind of neuromodulation.

Emotionally negative stimuli can overcome attentional deficits in patients with visuo-spatial hemineglect.

Left unilateral spatial neglect resulting from right brain damage is characterized by loss of awareness for stimuli in the contralesional side of space, despite intact visual pathways. We examined using fMRI whether patients with neglect are more likely to consciously detect in the neglected hemifield, emotionally negative complex scenes rather than visually similar neutral pictures and if so, what neural mechanisms mediate this effect. Photographs of emotional and neutral scenes taken from the IAPS were presented in a divided visual field paradigm. As expected, the detection rate for emotional stimuli presented in the neglected field was higher than for neutral ones. Successful detection of emotional scenes as opposed to neutral stimuli in the left visual field (LVF) produced activations in the parahippocampal and anterior cingulate areas in the right hemisphere. Detection of emotional stimuli presented in the intact right visual field (RVF) activated a distributed network of structures in the left hemisphere, including anterior and posterior cingulate cortex, insula, as well as visual striate and extrastriate areas. LVF-RVF contrasts for emotional stimuli revealed activations in right and left attention related prefrontal areas whereas RVF-LVF comparison showed activations in the posterior cingulate and extrastriate visual cortex in the left hemisphere. An additional analysis contrasting detected vs. undetected emotional LVF stimuli showed involvement of left anterior cingulate, right frontal and extrastriate areas. We hypothesize that beneficial role of emotion in overcoming neglect is achieved by activation of frontal and limbic lobe networks, which provide a privileged access of emotional stimuli to attention by top-down modulation of processing in the higher-order extrastriate visual areas. Our results point to the importance of top-down regulatory role of the frontal attentional systems, which might enhance visual activations and lead to greater salience of emotional stimuli for perceptual awareness.

New approach to the rehabilitation of post-stroke focal cognitive syndrome: effect of levodopa combined with speech and language therapy on functional recovery from aphasia.

OBJECTIVE: Few studies confirm that pharmacological treatments support post-stroke recovery. The purpose of this study was to determine whether the combination of levodopa with language therapy improves aphasia rehabilitation. METHODS: We did a prospective, randomized, placebo-controlled, double-blind study in which twenty patients received levodopa before each language therapy session, and an additional 19 received a placebo. Language training was provided during a 3-week period. The efficacy variables were changes from baseline in Boston Diagnostic Aphasia Examination (BDAE) scores. RESULTS: Patients receiving levodopa experienced greater language improvement in verbal fluency and repetition, compared to patients receiving placebo. Improvement was particularly distinct in patients with anterior lesions. CONCLUSIONS: Supplementing language therapy with levodopa may improve recovery from aphasia in patients with frontal lesions.

[Neuropsychological rehabilitation of patients with cognitive function disturbances in organic brain damage]. / Neuropsychologiczna rehabilitacja pacjentów z zaburzeniami funkcji poznawczych spowodowanymi uszkodzeniem mózgu.

A new neuropsychological method of rehabilitation of brain-injured patients with cognitive disorders is presented in the paper. The so called cognitive rehabilitation is based on computer programmes, prepared for typical syndromes of cognitive disorders. Research studies in this review refer to the effectiveness of that kind of therapy, indicating its confirmed values and some aspects to be explained yet.

[Severe meningoencephalitis in Borrelia burgdorferi infection]. / Ciezkie zapalenie opon mózgowo-rdzeniowych i mózgu w przebiegu zakazenia Borrelia burgdorferi.

We present a case of borreliosis with severe impairment of central nervous system. The patient a 43-year-old man, presented with neurological signs and symptoms and severe psychiatric disorders. The diagnosis was established several months after the onset of neurological signs. CSF examination revealed lymphocyte pleocytosis and specific antibodies against B. burgdorferi in high titres. MRI of the brain showed inflammatory lesions. Due to the treatment with antibiotics, patient's state improved and pleocytosis in CSF disappeared. However, after 1- year follow-up, specific antibodies were still present in high titres. Clinical manifestations and the results of diagnostic procedures show multifocal encephalitis in the acute phase of the disease and encephalopathy as a residual syndrome.

[Hemi-neglect syndrome. Clinical characteristics and reeducation management]. / Zespól polowiczego zaniedbywania. Charakterystyka kliniczna i postepowanie reedukacyjne.

The paper deals with hemi-neglect disorders which may occur in patients with right hemisphere lesions. Apart from description of the clinical symptomatology, with emphasis on the features most significant for the differential diagnosis, methods of neuropsychological rehabilitation were discussed.

[Hemi-neglect syndrome--case report]. / Zespól polowiczego zaniedbywania--opis przypadku.

A female patient with an ischaemic focal lesion in the non-dominant cerebral hemisphere due to stenosis of the right carotid artery is presented. Besides a mild left hemiparesis the clinical symptomatology included a pronounced hemi-neglect syndrome in the form of unilateral limb akinesia, a failure to respond to stimuli presented to the left of the midline as well as anosognosia and anosodiaphoria. Despite the 6-week rehabilitation training, the neglect syndrome was rather stabilized with only a slight tendency for improvement.

[Disorders of mental functioning in Wilson's disease]. / Zaburzenia psychiczne w chorobie Wilsona.

In this article we have presented a review of the literature on psychopathology in Wilson's disease. The descriptions of disorders connected with this disease are sometimes ambiguous, but they cover changes in behaviour and personality, affective disorders and deterioration of cognitive functioning. Psychopathological picture is being correlated with damages in certain cerebral sites and structures. It requires further study to learn about the role of the basal ganglia in higher mental functioning. Wilson's disease is one of the disorders to be analysed in order to broaden our knowledge about behavioral changes caused by damages in the basal ganglia.