Stroke: piracetam may help aphasia improve

Clinical bottom line (level 1a)

Patients with aphasia following a stroke who receive piracetam compared with placebo may have an improvement in symptoms (NNT = 6 at weeks) .

Greener et al: Cochrane Library 2001; 3 : -

Expires June 2004

The study

Systematic review of all randomised controlled trials of

Patients: aphasia following a stroke
Intervention: drug therapy compared with no drug therapy
Outcome: improvement in speech

Articles found in all languages using Cochrane Stroke Group trials regsiter and Medline, Cinahl, to May 2001 (search terms: detailed in text ) and hand-searching relevant journals, contacting authors experts in the fields, and reviewing reference lists of retrieved articles.

Selection criteria: by 1 reviewer and checked by another
Appraisal criteria: by 1 reviewer and checked by another using randomisation, allocation concealment, loss to follow-up
Articles excluded if:

aged < 18

10 RCTs found

5 comparing piracetam and placebo
1 comparing bifemelane and control
1 comparing piribedil and control
1 comparing bromocriptine and placebo
1 comparing idebenone and placebo
1 comparing dextran 40 and control

The evidence

piracetam v. placebo

Outcome	Time to outcome	CER	OR (95% CI)	NNT (95% CI)
improvement in aphasia	weeks	191/249 (76.7%)	0.46 (0.31 to 0.68)	6 (4 to 13)

Other studies were too small to report meaningful comparisons between the groups.

Comments

78% of patients randomised in the studies included in the piracetam meta-analysis were followed up.
It is unclear whether patients received piracetam in addition to aspirin.

Citation

Greener J, Enderby P, Whurr R: pharmacological treatment for aphasia following stroke. Cochrane Library 2001; 3 : -

Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, June 2002
Reviewer:

_{Clinical Question.}

_Patient	_{aphasia following a stroke}
_{Intervention or Exposure}	_{drug therapy}
_Comparison	_control
_Outcome	_{improvement in aphasia}