Levetiracetam and Speech Therapy in Aphasia from Penetrating Brain Injury. Could it be the Way To Recovery?

A previously healthy 26 years old right-handed mansustained a penetrating brain injury (PBI) from gunshotwound to the head. The bullet entered the right parietooccipitaljunction, traveled diagonally through the occipitalpole and ended in the left fronto-temporal lobe. Hedeveloped right hemiparesis and global aphasia. He wasenrolled in speech therapy (ST), and was started onlevetiracetam (LEV) 500 mg twice daily (BID) for seizureprophylaxis, then LEV was increased to 750mg BID.After 8 days on LEV 750 mg BID the patient pronouncedthe names of his children and answered questionsappropriately with verbal “yes” and “no”. At discharge,FIM scores in comprehension, expression, memory, andsocial interaction had all improved from 2 to 4. He wasable to respond verbally at the 1-3 word level with 50%accuracy and had shown improvement in auditorycomprehension and verbal expression. The patient waskept on LEV 750 mg BID for 7 months. He had 50outpatient ST sessions. At 9 months, he was able to reada paragraph he had written, and used a paper guide toscan lines. His comprehension of the written languageimproved to the sentence level, and his moneymanagement skills improved to modified independent.Conclusions: LEV appears to improve aphasia andcognitive outcomes of PBI patients treated with ST. Largeprospective randomized trials are needed to confirm thisclinical observation and to establish treatment protocolsfor PBI-induced aphasia that will incorporate ST and LEV.