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Summary Background Treatment guidelines for aphasia recommend intensive speech and language therapy for chronic (≥6 months) aphasia after stroke, but large-scale, class 1 randomised controlled trials on treatment effectiveness are scarce. We aimed to examine whether 3 weeks of intensive speech and language therapy under routine clinical conditions improved verbal communication in daily-life situations in people with chronic aphasia after stroke. Methods In this multicentre, parallel group, superiority, open-label, blinded-endpoint, randomised controlled trial, patients aged 70 years or younger with aphasia after stroke lasting for 6 months or more were recruited from 19 inpatient or outpatient rehabilitation centres in Germany. An external biostatistician used a computer-generated permuted block randomisation method, stratified by treatment centre, to randomly assign participants to either 3 weeks or more of intensive speech and language therapy (≥10 h per week) or 3 weeks deferral of intensive speech and language therapy. The primary endpoint was between-group difference in the change in verbal communication effectiveness in everyday life scenarios (Amsterdam–Nijmegen Everyday Language Test A-scale) from baseline to immediately after 3 weeks of treatment or treatment deferral. All analyses were done using the modified intention-to-treat population (those who received 1 day or more of intensive treatment or treatment deferral). This study is registered with ClinicalTrials.gov, number NCT01540383. Findings We randomly assigned 158 patients between April 1, 2012, and May 31, 2014. The modified intention-to-treat population comprised 156 patients (78 per group). Verbal communication was significantly improved from baseline to after intensive speech and language treatment (mean difference 2·61 points [SD 4·94]; 95% CI 1·49 to 3·72), but not from baseline to after treatment deferral (−0·03 points [4·04]; −0·94 to 0·88; between-group difference Cohen's d 0·58; p=0·0004). Eight patients had adverse events during therapy or treatment deferral (one car accident [in the control group], two common cold [one patient per group], three gastrointestinal or cardiac symptoms [all intervention group], two recurrent stroke [one in intervention group before initiation of treatment, and one before group assignment had occurred]); all were unrelated to study participation. Interpretation 3 weeks of intensive speech and language therapy significantly enhanced verbal communication in people aged 70 years or younger with chronic aphasia after stroke, providing an effective evidence-based treatment approach in this population. Future studies should examine the minimum treatment intensity required for meaningful treatment effects, and determine whether treatment effects cumulate over repeated intervention periods. Funding German Federal Ministry of Education and Research and the German Society for Aphasia Research and Treatment.

Intraarterial thrombolytic therapy can be life-saving in patients with vertebrobasilar occlusion. Thrombotic occlusions of the internal carotid artery or middle cerebral artery often result in disabling ischemic cerebral infarctions. Local fibrinolysis may help to minimize the neurological sequelae. Indications and contraindications for such a therapy are not yet well established, and more discussion is needed. During the last 2 years we have treated 18 patients with occlusions of vessels supplying the brain by means of local intraarterial thrombolytic therapy with urokinase. These included 5 patients who presented with internal carotid/middle cerebral artery occlusions, 3 of whom left the hospital with only minor neurological deficits while 2 died despite therapy. The other 13 patients had acute vertebrobasilar occlusion: 6 patients survived, 3 with a good general condition and 2 with locked-in syndrome. Technique, dosage of urokinase and patient selection are discussed as well as the outcome.

Regelhafte biologische Funktionen und ihre Storungen konnen bei psychiatrischen Erkrankungen als dispositionelle Faktoren und/oder als symptombegrundende und -begleitende Faktoren bedeutsam sein. Im Augenblick ist es nicht moglich, irgendeinen biochemischen Parameter in einen spezifischen Zusammenhang mit Atiologie, Symptomen oder Verlauf von psychiatrischen Erkrankungen zu bringen. Diese Tatsache war in den vergangenen Jahren Anlas dafur, neue Forschungsrichtungen in der biologischen Psychiatrie einzuschlagen, die im wesentlichen durch zwei Punkte gekennzeichnet sind: 1. Gruppen von Patienten aber auch gesunden Probanden werden auf der Basis gleicher biochemischer Merkmale, aber nicht gleicher Diagnose zusammengestellt, um dann psychologische oder psychopathologische Merkmale zwischen solchen biochemisch quasi „homogenen“ Gruppen zu analysieren. 2. Es wird bei solchen Forschungen versucht, einen Zusammenhang zwischen dem biochemischen Parameter und einem psychologischen oder einem Verhaltensmerkmal herzustellen, und nicht mit einer psychiatrischen Diagnose. Beschreibbare Verhaltenseigenschaften wiederum konnen leichter mit neurophysiologischen Funktionsveranderungen oder Transmittersystemen im ZNS in Verbindung gebracht werden, da fur solche Verhaltensparameter haufig tierexperimentelle Modelle zur Verfugung stehen.

Evidence for the operation of genetic factors in the origin of major psychiatric diseases led to the suggestion that neurochemical variants might be identifiable in the cellular systems of patients suffering from these illnesses. The discovery of one or more of such genetic markers, susceptible to objective evaluation, would be of great theoretical and practical importance. As Kety recently pointed out, “it was such discoveries in the field of mental retardation which made possible the progress that has occurred in the delineation of homogenous subtypes, the elucidation of genetic transmission and their metabolic concomitants” (Kety 1981).