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July 8, 2002

Aphasia just one complication of stroke sufferers

By Alicia Sands Lurry

As many as 25 percent of stroke victims suffer from a serious loss of speech and language comprehension. The affliction is commonly known as aphasia, and it is frustrating for patients and caregivers alike. It is estimated that more than 1 million Americans suffer from some form of aphasia, which can result from a stroke, brain tumor, seizure, Alzheimer’s disease or head trauma.

“Aphasia is a very specific condition that deals with disorder of language,” said Michael Frankel, associate professor of neurology at the School of Medicine and chief of neurology at Grady Hospital. “The easiest way to explain it is that a person can’t express what he wants to say or cannot find the right words, or that someone else finds it difficult to understand what the person is saying.

“It all depends, of course, on how much of the brain is damaged,” Frankel continued. “Damage usually occurs on the left side of the brain for people who are right-handed. Left-handers are also more likely to have language function located in the left hemisphere of the brain, but some have it on the right side of the brain.”

Frankel noted, however, a difference between aphasia and another disorder known as dysarthria, which is characterized as a problem of articulation. Both conditions can occur from stroke or in tandem.

A patient with aphasia, for example, may not be able to understand or express what she wants to say. A person with dysarthria, on the other hand, understands everything and can express what she wants to say, but when she tries to use muscles in the mouth and throat to speak, it becomes difficult to coordinate them correctly, resulting in slurred speech.

If a stroke is the cause of aphasia, speech therapy can help treat it, said Frankel, who played an integral role in establishing Operation Stroke For Atlanta, a multiorganizational group focusing on educating health professionals as well as the community about stroke.

Some aphasia patients, however, do not undergo speech therapy but nevertheless show signs of improvement. Frankel said it is important to recognize aphasia as a symptom of stroke since difficulty speaking can often be a warning sign. A person can exhibit signs of aphasia prior to suffering a stroke.

“If a person has five minutes of difficulty speaking where the words don’t come out, or they come out mixed up, that may be a warning sign of a stroke—even if it lasts just a few minutes,” Frankel said.

The warning signs of stroke also include sudden weakness on one side of the body or sudden numbness. This is often a sign of a transient ischemic attack, signifying that something is wrong with the blood vessels in the brain. At this stage it is often possible to introduce treatment to intervene and prevent another stroke from occurring. A stroke occurs when part of the brain is deprived of oxygen and affected nerve cells die. The brain cells that are killed cannot operate. The result is weakness, paralysis, or difficulty speaking, like aphasia.

There is no known cure for aphasia. According to the National Aphasia Association, 66 percent of aphasia cases result from stroke. Some patients are fortunate to recover completely within the first few hours or days. This is known as transient aphasia.

If aphasia symptoms persist beyond the first two to three months after a stroke, a complete recovery is unlikely. Recovery is a slow process that usually requires a minimum of a year of treatment including helping the individual and family understand and adjust to long-term deficits.

Earlier this year, Frankel was appointed vice president of the southeastern affiliate of the American Heart Association. During his three-year term in office, Frankel will help orchestrate the activities of the American Heart Association and the American Stroke Association in their mission to fight heart disease and stroke.