PubMed Health⌕ Search

Biomedical subjects

W D Heiss

Publications and source records attributed to W D Heiss.

At least 55 records · Page 3Linked to original sources
PubMed2001

Predictive value of neurochemical monitoring in large middle cerebral artery infarction.

BACKGROUND AND PURPOSE: Space-occupying brain edema is a life-threatening complication in patients with large hemispheric stroke. Early identification of patients at risk is necessary to decide on invasive therapies such as decompressive hemicraniectomy or hypothermia. To assess potential predictors of malignant brain edema by measurement of intracranial pressure (ICP) and microdialysis in patients with large hemispheric stroke and different clinical course. METHODS: In an ongoing prospective clinical study, an ICP and microdialysis probe were placed into the parenchyma of the ipsilateral frontal lobe of 10 patients. Extracellular concentrations of glutamate, lactate, pyruvate, and glycerol were measured continuously. Repeated cranial CT scans were scrutinized for size of infarction and presence of mass effect. RESULTS: The dynamics of the different substances varied in accordance with the clinical course, size of infarction, and local brain edema: Increase in ICP and in glutamate concentration and lactate-pyruvate ratio was followed by massive edema and large infarcts; generally low and stable ICP and substrate concentrations were found in patients without progressive space-occupying infarcts. CONCLUSIONS: In patients with large hemispheric infarction, bedside monitoring with microdialysis is feasible and might be helpful together with ICP recording to follow the development of malignant brain edema.

Adult↗
PubMed2001

Imaging the ischemic penumbra and treatment effects by PET.

Active treatment of acute ischemic stroke can only be successful as long as tissue in the area of ischemic compromise is still viable. Therefore, the identification of the area of irreversible damage, and its distinction from the penumbral zone, i.e., tissue with impaired function but preserved morphology, may improve the estimation of the potential efficacy of various therapeutic strategies. This can be achieved by multi-tracer positron emission tomography (PET), perfusion-weighted and diffusion-weighted magnetic resonance imaging in experimental models. Neuroimaging modalities applied in patients with acute ischemic stroke cannot reliably identify penumbra tissue and detect irreversible damage in the first hours after stroke, when treatment must be initiated to have the potential for success: multitracer studies for the assessment of flow and irreversible metabolic damage usually are limited in the clinical setting, and arterial blood sampling necessary for quantitative determinations is prohibited under certain circumstances, e.g., when thrombolysis is planned. The range of the penumbra can be assessed by combining determinations of flow and benzodiazepine receptor binding by PET of H2(15)O and 11C-flumazenil (FMZ) and relating flow values and FMZ binding to the final state of the tissue. By this approach, cumulative probability curves can be computed to predict eventual infarction or non-infarction and to define the penumbral range. The computed values are in good agreement with results from other studies proving the validity of the concept of the penumbra which was also demonstrated in several therapeutic studies in which thrombolytic treatment reversed critical ischemia and decreased the volume of the final infarcts. Such neuroimaging findings might serve as surrogate targets in the selection of other therapeutic strategies for large clinical trials.

Animals↗
PubMed2001

Continuing cognitive impairment after isolated transient global amnesia.

Fourteen patients were investigated 3-4 days after end of their transient global amnesia (TGA) with a number of neuropsychological tests. Their performance was compared with that of a control group, matched for age, education, and profession. It was found that in spite of the common definition of TGA, impairments in both verbal and non-verbal long term memory and verbal fluency persisted and were in fact impaired to such a degree that it seemed unlikely that full recovery would have occurred within the next few days. We propose a major role of stress in the etiology and the recovery process of TGA and consider it likely that stress hormones are of major influence both in the triggering of TGA and the subsequent continuation of cognitive impairments.

Aged↗
PubMed2001

Relation between 1H MR spectroscopic imaging and regional cerebral glucose metabolism in Alzheimer's disease.

1 H Magnetic resonance spectroscopic imaging (MRSI) and positron emission tomography (PET) of (18) F-2-fluoro-2-deoxy-D-glucose (FDG) were performed in 18 patients with probable Alzheimer's disease (AD) and 3 normal controls. We measured the distribution and relative signal intensities of N-acetyl aspartate (NAA; a presumed neuronal marker), choline residues (Cho) representing cellular membrane compounds and of creatine-containing metabolites (Cr), and correlated these to regional cerebral glucose metabolism (rCMRGI) after coregistration of both imaging-techniques. The pattern of choline was significantly different between AD and normals (p < 0.01). RCMRGI was significantly related to Cho/Cr (r=-0.21, p<.05) and NAA/Cho quotients (r=0.35, p<.001). Our results suggest that in AD reduced neuronal energy performance and membrane abnormalities contribute to metabolic deterioration.

Adult↗
PubMed2001

Possible control of intermittent cerebral ischemia by monitoring of direct-current potentials.

OBJECT: Neurosurgically induced temporary occlusion of intracranial arteries carries the risk of cerebral ischemic damage. Because negative shifts in the cortical direct-current (DC) potential indicate tissue depolarization and, thus, critical ischemic stress, the authors hypothesized that recordings of these potentials could help to determine the optimal duration and frequency of induced intermittent focal ischemia to prevent brain injury. The investigators related the results of DC recordings both to simultaneously recorded decreases in extracellular Ca++ concentration ([Ca++]o), which reflect Ca++ entry into cells, and to histological outcome. METHODS: In cats anesthetized with halothane the effects of intermittent brief (10 minutes long, six times [6 x 10-min group]) and prolonged (20 minutes long, three times [3 x 20-min group]) episodes of middle cerebral artery occlusions were compared with those of a single continuous episode (1 x 60-min group). Laser Doppler flow probes and ion-selective microelectrodes were used to measure cerebral blood flow, DC potentials, and [Ca++]o in cortical tissues of ectosylvian gyri. Negative shifts in DC potential were evaluated in the three groups during the entire 60-minute-long period of ischemia and were smallest in the 6 x 10-min group, larger in the 3 x 20-min group, and largest in the 1 x 60-min group. Accordingly, infarct volumes were smallest in the 6 x 10-min group, intermediate in the 3 x 20-min group, and largest in the 1 x 60-min group. Decreases in ischemic [Ca++]o were significantly greater in the 1 x 60-min group than in the two groups in which there were repetitive occlusions, and recovery of [Ca++]o after reperfusion normalized only in the 1 x 60-min group. CONCLUSIONS: The DC potential may provide a reliable measure to optimize intermittent ischemia and to achieve minimal ischemic brain injury during temporary neurosurgical occlusion of cerebral arteries.

Animals↗
PubMed2001

Restitution of alpha-topography by piracetam in post-stroke aphasia.

OBJECTIVE: Electroencephalographic and clinical effects of piracetam in post-stroke aphasia were evaluated in a prospective, randomized, double-blind, placebo-controlled trial. METHODS: In 24 patients with mild to moderate aphasia after ischemic stroke, quantitative topographic EEG at rest was studied before and after a 6-week treatment period. RESULTS: In the active treatment group, a significant shift in the alpha-rhythm from frontal to occipital regions was observed which may be due to a restitution of corticothalamic circuits involved in the generation of alpha-activity. CONCLUSION: Neuropsychological scores improved significantly and markedly in various domains of speech during piracetam treatment, whereas improvements were less marked and restricted to a few categories in the placebo group.

Adult↗
PubMed2001

Positron emission tomographic analysis of the nigrostriatal dopaminergic system in familial parkinsonism associated with mutations in the parkin gene.

A kindred from South Tyrol (northern Italy) with familial, adult-onset parkinsonism of pseudo-dominant inheritance and mutations in the parkin gene was recently described. To gain insight into basal ganglia dysfunction in this form of hereditary parkinsonism, positron emission tomography (PET) with 18-fluorodopa (FDOPA) and 11C-raclopride (RAC) was performed in 5 affected family members and 5 asymptomatic relatives with proven compound heterozygous or heterozygous parkin mutations. Results were compared to findings in healthy control subjects and patients with typical sporadic, idiopathic Parkinson's disease. Similar to findings in the sporadic Parkinson's disease group, presynaptic striatal FDOPA storage was decreased in patients with compound heterozygous parkin mutations, with the most prominent reduction in the posterior part of the putamen. Along with the presynaptic lowered FDOPA uptake, we found a uniform reduction of the striatal 11C-raclopride binding index in all affected family members as compared to asymptomatic family members carrying a heterozygous parkin mutation, sporadic Parkinson's disease, and control subjects. Our PET data provide evidence that parkinsonism in this family is associated with presynaptic dopaminergic dysfunction similar to idiopathic Parkinson's disease pathophysiology, along with alterations at the postsynaptic D2 receptor level. In asymptomatic carriers of a single parkin mutation with an apparently normal allele, we found a mild but statistically significant decrease of mean FDOPA uptake compared to control subjects in all striatal regions. These data indicate a preclinical disease process in these subjects.

Adult↗
PubMed2001

Quantitative kinetics of [124I]FIAU in cat and man.

UNLABELLED: For the assessment of the efficacy of clinical gene therapy trials, different imaging modalities have been developed that enable a noninvasive assessment of location, magnitude, and duration of transduced gene expression in vivo. These imaging methods rely on a combination of an appropriate marker gene and a radiolabeled or paramagnetic marker substrate that can be detected by PET or MRI. Here, we assess whether the nucleoside analog 2'-fluoro-2'-deoxy-1beta-D-arabinofuranosyl-5-iodouracil (FIAU), a specific marker substrate for herpes simplex virus type 1 thymidine kinase (HSV-1-tk) gene expression, penetrates the blood-brain barrier (BBB) as an essential prerequisite for a noninvasive assessment of HSV-1-tk gene expression in gliomas. METHODS: No-carrier-added [(124)I]FIAU was synthesized by reacting the precursor 2'-fluoro-2'-deoxy-1beta-D-arabinofuranosyluracil (FAU) with carrier-free [(124)I]NaI. The course of biodistribution of [(124)I]FIAU was investigated in anesthetized cats (n = 3; organs) and in one patient with a recurrent glioblastoma (plasma and brain) by PET imaging over several hours (cats, 1-22 h) to several days (patient, 1-68 h). FIAU PET was performed in conjunction with multitracer PET imaging (cerebral blood flow and cerebral metabolic rate of O(2) in cats only; cerebral metabolic rate of glucose and [(11)C]methionine in all subjects). A region-of-interest analysis was performed on the basis of coregistered high-resolution MR images. The average radioactivity concentration was determined, decay corrected, and recalculated as percentage injected dose per gram of tissue (%ID/g) or as standardized uptake values (SUVs). RESULTS: The average chemical yield of [(124)I]FIAU synthesis was 54.6% +/- 6.8%. The chemical and radiochemical purities of [(124)I]FIAU were found to be >98% and >95%, respectively. In cats, the kinetic analysis of [(124)I]FIAU-derived radioactivity showed an early peak (1-2 min after injection) in heart and kidneys (0.20 %ID/g; SUV, 4.0) followed by a second peak (10-20 min after injection) in liver and spleen (0.16 %ID/g; SUV, 3.2) with subsequent clearance from tissues and a late peak in the bladder (10-15 h after injection). In the unlesioned cat brain, no substantial [(124)I]FIAU uptake occurred throughout the measurement (<0.02 %ID/g; SUV, <0.4). In the patient, [(124)I]FIAU uptake in normal brain was also very low (<0.0002 %ID/g; SUV, <0.16). In contrast, the recurrent glioblastoma revealed relatively high levels of [(124)I]FIAU-derived radioactivity (5-10 min after injection; 0.001 %ID/g; SUV, 0.8), which cleared slowly over the 68-h imaging period. CONCLUSION: The PET marker substrate FIAU does not penetrate the intact BBB significantly and, hence, is not the marker substrate of choice for the noninvasive localization of HSV-1-tk gene expression in the central nervous system under conditions in which the BBB is likely to be intact. However, substantial levels of [(124)I]FIAU-derived radioactivity may occur within areas of BBB disruption (e.g., glioblastoma), which is an essential prerequisite for imaging clinically relevant levels of HSV-1-tk gene expression in brain tumors after gene therapy by FIAU PET. For this purpose, washout of nonspecific radioactivity should be allowed for several days.

Animals↗
PubMed2000

In-vivo measurements of regional acetylcholine esterase activity in degenerative dementia: comparison with blood flow and glucose metabolism.

UNLABELLED: Memory and attention are cognitive functions that depend heavily on the cholinergic system. Local activity of acetylcholine esterase (AChE) is an indicator of its integrity. Using a recently developed tracer for positron emission tomography (PET), C-11-labeled N-methyl-4-piperidyl-acetate (C11-MP4A), we measured regional AChE activity in 4 non-demented subjects, 4 patients with dementia of Alzheimer type (DAT) and 1 patient with senile dementia of Lewy body type (SDLT), and compared the findings with measurements of blood flow (CBF) and glucose metabolism (CMRGlc). Initial tracer extraction was closely related to CBF. AChE activity was reduced significantly in all brain regions in demented subjects, whereas reduction of CMRGlc and CBF was more limited to temporo-parietal association areas. AChE activity in SDLT was in the lower range of values in DAT. Our results indicate that, compared to non-demented controls, there is a global reduction of cortical AChE activity in dementia. KEYWORDS: Dementia, cholinergic system, acetylcholine esterase, positron emission tomography, cerebral blood flow, cerebral glucose metabolism.

Acetates↗
PubMed2000

FDG- and Dopa-PET in postencephalitic parkinsonism.

We report a case of a 74-year old woman who following an acute virus encephalitis developed an akinetic-rigid Parkinson syndrome with tremor, hypokinesia, hypomimia, rigidity and cogwheel phenomenon in all four extremities, brady-dysdiadochokinesia as well as myoclonic jerks of the arms. Many of the clinical features of this postencephalitic parkinsonism (PEP) suggested the diagnosis of sporadic encephalitis lethargica, first described by von Economo 1917. Cerebral spinal fluid showed signs of a viral encephalitis, and a positive influenza A IgA-antibody titer (1:>160) in the viral serologic screen was found. Positron emission tomography (PET) showed an altered pattern of glucose- and dopa-metabolism clearly different from findings in idiopathic Parkinson syndrome (IPS). The acute lack of inhibitory input from the substantia nigra pars compacta to the striatum could explain the different metabolic patterns in our case in comparison to IPS patients. Our findings indicate that PEP may also be caused by influenza A and furthermore that PET clearly distinguishes PEP from IPS.

Aged↗
PubMed2000

Interictal hippocampal benzodiazepine receptors in temporal lobe epilepsy: comparison with coregistered hippocampal metabolism and volumetry.

The significance of benzodiazepine receptor (BZR) concentration in comparison with hippocampal metabolism and volumetry was assessed in 14 patients diagnosed with temporal lobe epilepsy (TLE) without hippocampal signal change on T2-weighted magnetic resonance imaging (MRI) scans. Focus lateralization was achieved by clinical, electroencephalographic and neuropsychological examinations. Three-dimensional positron emission tomography (PET) and MRI scans were coregistered for determination of hippocampal 11C-flumazenil (FMZ) binding, normalized to average cortical values for glucose metabolism (rCMRglc) and volume. The hippocampi were individually outlined on T1-weighted MRI. Volumes of interest (VOI) were used for calculation of asymmetries between clinically affected and unaffected sides. Eleven out of 14 TLE patients presented a significant reduction in hippocampal volume. In nine of these 11 patients hippocampal FMZ binding and in seven cases hippocampal CMRglc was also reduced. In two patients without hippocampal volume asymmetry FMZ binding was markedly reduced in the mesial temporal lobe appropriately to the clinically diagnosed side. In our study volumetry is therefore the most sensitive tool for the detection of hippocampal abnormality in TLE. However, in cases without hippocampal atrophy the reduction of FMZ may indicate functional impairment of BZR before neuronal loss becomes evident. Our results emphasize the complementary nature of these tests in TLE patients.

Adult↗
PubMed2000

Ischemic penumbra: evidence from functional imaging in man.

The ischemic penumbra is defined as tissue with flow within the thresholds for maintenance of function and of morphologic integrity. Penumbra tissue has the potential for recovery and therefore is the target for interventional therapy in acute ischemic stroke. The identification of the penumbra necessitates measuring flow reduced less than the functional threshold and differentiating between morphologic integrity and damage. This can be achieved by multitracer positron emission tomography (PET) and perfusion-weighted (PW) and diffusion-weighted magnetic resonance imaging (DW-MRI) in experimental models, in which the recovery of critically perfused tissue or its conversion to infarction was documented in repeat studies. Neuroimaging modalities applied in patients with acute ischemic stroke--multitracer PET, PW- and DW-MRI, single photon emission computed tomography (SPECT), perfusion, and Xe-enhanced computed tomography (CT)-- often cannot reliably identify penumbra tissue: multitracer studies for the assessment of flow and irreversible metabolic damage usually cannot be performed in the clinical setting; CT and MRI do not reliably detect irreversible damage in the first hours after stroke, and even DW-MRI may be misleading in some cases: determinations of perfusion alone yield a poor estimate of the state of the tissue as long as the time course of changes is not known in individual cases. Therefore, the range of flow values in ischemic tissue found later, either within or outside the infarct, was rather broad. New tracers--for example, receptor ligands or hypoxia markers--might improve the identification of penumbra tissue in the future. Despite these methodologic limitations, the validity of the concept of the penumbra was proven in several therapeutic studies in which thrombolytic treatment reversed critical ischemia and decreased the volume of final infarcts. Such neuroimaging findings might serve as surrogate targets in the selection of other therapeutic strategies for large clinical trials.

Animals↗
PubMed2000

Functional imaging correlates of recovery after stroke in humans.

The mechanisms that are responsible for the remarkable potential for functional recovery from stroke in humans remain unclear, and functional tomographic neuroimaging techniques increasingly are being used to investigate this issue. Such studies confirmed that recovery of function is related to the volume of penumbra tissue that escapes infarction. For language, reactivation of the primary functional areas in the dominant hemisphere is associated with the best prognosis. Evidence for functional plasticity in the immediate vicinity of infarcts, as demonstrated under experimental conditions with invasive methods, is still limited after stroke in humans, probably because of the limitations of spatial resolution of most currently available methods. Often, functional changes in the large-scale networks that support motor (for example, supplementary and premotor cortex) and language functions (for example, prefrontal cortex) have been found, more extensively after lesions acquired during childhood than at adult age. A frequent finding is an increase in the cerebral blood flow response in corresponding regions of the healthy hemisphere during unilateral motor activation or language activation. It is, however, not yet clear whether that is related to functional recovery, and there are several observations indicating that it is often inefficient. Further systematic follow-up studies and therapeutic intervention trials are needed to clarify these issues.

Humans↗
PubMed2000

Multiple interstitial substances measured by microdialysis in patients with subarachnoid hemorrhage.

OBJECTIVE: Intracerebral microdialysis is a tool to monitor metabolic disturbances in the brains of patients with severe head injuries or subarachnoid hemorrhage (SAH). In the search for putative indicators of primary and secondary brain damage, we measured multiple metabolites in the dialysates of patients with SAH, to elucidate their significance for the outcomes of the patients as well as their temporal profiles of liberation after the insult. METHODS: Microdialysis probes were placed, with a ventriculostomy catheter for drainage of cerebrospinal fluid, into a frontal lobe of 10 patients with aneurysmal SAH, for 4.6 +/- 0.5 days. Amino acids, metabolites of glycolysis, purines, catecholamines, and nitric oxide oxidation byproducts were measured by high-performance liquid chromatography. Spearman's correlation coefficient and Student's t test were used to compare the levels of the metabolites with the outcomes of the patients, as assessed using the Glasgow Outcome Scale, 3 months after the ictus. RESULTS: For patients with unfavorable outcomes (Glasgow Outcome Scale scores of 1-3), which were primarily associated with the development of large infarctions, dialysate levels of excitatory amino acids increased up to 30-fold, those of lactate up to 10-fold, and those of nitrite up to 5-fold, compared with normal levels observed for patients with favorable outcomes (Glasgow Outcome Scale scores of 4 or 5). When average peak concentrations in the dialysates of patients with favorable and unfavorable outcomes were compared, significantly higher levels of excitatory amino acids, taurine, lactate, and nitrite, but not of purines and catecholamines, were observed for those with poor outcomes (P < 0.05). With respect to the temporal profiles of the average metabolite concentrations, the significantly increased levels of amino acids observed for patients with poor outcomes followed a biphasic course, with maximal concentrations on the first and second days or the seventh day after the insult (P < 0.01). CONCLUSION: These data confirm the usefulness of excitatory amino acids and lactate as major parameters for neurochemical monitoring for patients threatened by acute cerebral disorders. Other substances, such as taurine and nitrite, were also demonstrated to be potentially predictive. Release of these substances into the extracellular fluid of the brain might be particularly relevant for the development of secondary brain damage after SAH, e.g., infarction or brain swelling.

Acute Disease↗
PubMed2000

Early [(11)C]Flumazenil/H(2)O positron emission tomography predicts irreversible ischemic cortical damage in stroke patients receiving acute thrombolytic therapy.

BACKGROUND AND PURPOSE: Central benzodiazepine receptor ligands, such as [(11)C]flumazenil (FMZ), are markers of neuronal integrity and therefore might be useful in the differentiation of functionally and morphologically damaged tissue early in ischemic stroke. We sought to assess the value of a benzodiazepine receptor ligand for the early identification of irreversible ischemic damage to cortical areas that cannot benefit from reperfusion. METHODS: Eleven patients (7 male, 4 female, aged 52 to 75 years) with acute, hemispheric ischemic stroke were treated with alteplase (recombinant tissue plasminogen activator; 0.9 mg/kg according to National Institute of Neurological Disorders and Stroke protocol) within 3 hours of onset of symptoms. At the beginning of thrombolysis, cortical cerebral blood flow ([(15)O]H(2)O) and FMZ binding were assessed by positron emission tomography (PET). Those early PET findings were related to the change in neurological deficit (National Institutes of Health Stroke Scale) and to the extent of cortical damage on MRI or CT 3 weeks after the stroke. RESULTS: Hypoperfusion was observed in all cases, and in 8 patients the values were below critical thresholds estimated at 12 mL/100 g per minute, comprising 1 to 174 cm(3) of cortical tissue. Substantial reperfusion was seen in most of these regions 24 hours after thrombolysis. In 4 cases, distinct areas of decreased FMZ binding were detected. Those patients suffered permanent lesions in cortical areas corresponding to their FMZ defects (112 versus 146, 3 versus 3, 2 versus 1, and 128 versus 136 cm(3)). In the other patients no morphological defects were detected on MRI or CT, although blood flow was critically decreased in areas ranging in size up to 78 cm(3) before thrombolysis. CONCLUSIONS: These findings suggest that imaging of benzodiazepine receptors by FMZ PET distinguishes between irreversibly damaged and viable penumbra tissue early after acute stroke.

Aged↗
PubMed2000

One-year follow-Up in acute stroke patients treated with rtPA in clinical routine.

BACKGROUND AND PURPOSE: A recent placebo-controlled study provided evidence of a sustained benefit at 1 year from systemic thrombolysis in patients with acute ischemic stroke. The scope of the present study is to determine whether comparable results may be attained in everyday practice if current management guidelines are closely met. METHODS: Between March 1996 and July 1998, 150 consecutive patients with acute ischemic stroke were treated with systemic thrombolysis using alteplase, strictly in accordance with American Heart Association (AHA) guidelines. The patients were followed up for 12 months after treatment. RESULTS: Baseline characteristics and complication rates were comparable to those of the National Institute of Neurological Disorders and Stroke (NINDS) study, except for a somewhat younger age (mean 63 years) and lower National Institutes of Health Stroke Scale score (median 11). At 1 year, 41% of our patients showed minimal or no disability (Rankin scale score of 0 or 1), comparable to 41% in the NINDS rtPA group. The overall rate of recurrent stroke was 6.6% and the transient ischemic attack rate 3.3% at 1 year. Six patients (4%) died after the first 3 months, none of them due to recurrent stroke, and 5 had already been severely disabled at 3 months. CONCLUSIONS: These observations further encourage the routine use of rtPA for the treatment of acute ischemic stroke in strict accordance with the AHA guidelines.

Acute Disease↗
PubMed2000

Piracetam improves activated blood flow and facilitates rehabilitation of poststroke aphasic patients.

BACKGROUND AND PURPOSE: In a prospective, double-blind, placebo-controlled study, it was investigated whether piracetam improves language recovery in poststroke aphasia assessed by neuropsychological tests and activation PET measurement of cerebral blood flow. METHODS: Twenty-four stroke patients with aphasia were randomly allocated to 2 groups: 12 patients received 2400 mg piracetam twice daily, 12 placebo. Before and at the end of the 6-week treatment period in which both groups received intensive speech therapy, the patients were examined neuropsychologically and studied with H(2)(15)O PET at rest and during activation with a word-repetition task. Blood flow was analyzed in 14 language-activated brain regions defined on reconstructed surface views from MRI coregistered to the PET images. RESULTS: Before treatment, both groups were comparable with respect to performance in language tasks and to type and severity of aphasia. In the piracetam group, increase of activation effect was significantly higher (P:<0.05) in the left transverse temporal gyrus, left triangular part of inferior frontal gyrus, and left posterior superior temporal gyrus after the treatment period compared with the initial measures. The placebo group showed an increase of activation effect only in the left vocalization area. In the test battery, the piracetam group improved in 6 language functions, the placebo group only in 3 subtests. CONCLUSIONS: Piracetam as an adjuvant to speech therapy improves recovery of various language functions, and this effect is accompanied by a significant increase of task-related flow activation in eloquent areas of the left hemisphere.

Adolescent↗