Seventh cervical nerve neurotomy may augment speech therapy in patients with chronic aphasia post-stroke

1. Among patients with chronic aphasia post-stroke, right neurotomy of the seventh cervical nerve (C7) plus intensive speech and language therapy (SLT) was superior to intensive SLT alone in improving language function. 

Evidence Rating Level: 1 (Excellent)

Aphasia is one of the most common conditions of cerebrovascular events. Chronic post-stroke aphasia refers to language impairment that persists for more than a year after stroke. Approximately 80% patients with aphasia following left hemispheric stroke also experience right spastic arm paralysis. Previous studies have reported that patients with left sided stroke, spastic arm paralysis, and aphasia showed improved language function after transfer surgery of the seventh cervical nerve (C7). It was hypothesized that C7 neurotomy combined with standard intensive speech and language therapy (SLT) for chronic post-stroke aphasia may have an additive effect on improving language function. This study thus examined whether right-sided C7 neurotomy combined with intensive SLT was more effective in improving language function in patients with chronic aphasia after a left hemispheric stroke compared to SLT alone. This was a multicenter, assessor-blinded, randomized controlled trial in four centers in Shanghai, China. Patients aged 40-65 with chronic post-stroke aphasia were included and randomized 1:1 to receive either right-sided C7 neurotomy plus three weeks of intensive SLT (neurotomy plus SLT group) or three weeks of intensive SLT only (control group). Out of the 50 included in the study, 25 were in the neurotomy plus SLT group (mean [SD] age, 53.0 [6.3], men [%], 20 [80.0]) and 25 were in the control group (mean [SD] age, 52.1 [7.5], men [%], 19 [76.0]). From baseline to one month, the mean increase in Boston naming test (BNT) score was 11.16 points in the neurotomy plus SLT group and 2.72 points in the control group (difference 8.51 points, 95% confidence interval (CI) 5.31 to 11.71, P<0.001). The between-group difference in BNT score remained stable at six months (group difference 8.26 points, 4.16 to 12.35, P<0.001). During this period, the neurotomy plus SLT group also showed greater improvement in the aphasia quotient compared to the control group (difference 7.06 points, 4.41 to 9.72, P<0.001). Similar results were found for patient-reported activities of daily living and post-stroke depression. There were no reports of treatment-related severe adverse events. Overall, this study found that C7 neurotomy plus intensive SLT was associated with a greater improvement in language function compared with intensive SLT alone, indicating that right-sided C7 neurotomy plus intensive SLT may be a promising intervention for patients with chronic post-stroke aphasia. Future studies should confirm these findings in other populations. 

Click to read the study in BMJ

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