title: Piracetam Improves Activated Blood Flow and Facilitates Rehabilitation of Poststroke Aphasic Patients The effect of piracetam on short- and long-term verbal retrieval in dyslexic boys. Evaluation of the efficacy of piracetam in treating information processing, reading and writing disorders in dyslexic children. Aphasia in acute stroke: Incidence, determinants, and recovery Does long term use of piracetam improve speech disturbances due to ischemic cerebrovascular diseases? Effect of Piracetam on Recovery and Rehabilitation After Stroke: A Double‐Blind, Placebo‐Controlled Study Retrieving randomized controlled trials from medline: a comparison of 38 published search filters. [Dyslexia: clinical, neurophysiological and neuropsychological manifestations during the treatment with nootropil]. Treatment of acute ischemic stroke with piracetam. Members of the Piracetam in Acute Stroke Study (PASS) Group. Aphasia, Depression, and Non-Verbal Cognitive Impairment in Ischaemic Stroke Piracetam as an adjuvant to language therapy for aphasia: a randomized double-blind placebo-controlled pilot study. Piracetam and Dyslexia: Effects on Reading Tests Restitution of alpha-topography by piracetam in post-stroke aphasia. Increase in the power of human memory in normal man through the use of drugs
abstract: Background and Purpose In a prospect i ve , double-blind , placebo-controlled study , it was investigated whether piracetam improves language recovery in poststroke aphasia assessed by neuropsychological tests and activation PET measurement of cerebral blood flow . Methods Twenty-four stroke patients with aphasia were r and omly allocated to 2 groups : 12 patients received  2400 mg piracetam twice daily , 12 placebo . Before and at the end of the 6-week treatment period in which both groups received intensive speech therapy , the patients were examined neuropsychologically and studied with H215O PET at rest and during activation with a word-repetition task .  Blood flow was analyzed in 14 language -activated brain regions defined on reconstructed surface views from MRI coregistered to the PET images . Results Before treatment , both groups were comparable with respect to performance in language tasks and to type and severity of aphasia . In the piracetam group , increase of activation effect was significantly higher ( P < 0.05 ) in the left transverse temporal gyrus , left triangular part of inferior frontal gyrus , and left posterior superior temporal gyrus after the treatment period compared with the initial measures . The placebo group showed an increase of activation effect only in the left vocalization area . In the test battery , the piracetam group improved in 6 language functions , the placebo group only in 3 subtests . Conclusions Piracetam as an adjuvant to speech therapy improves recovery of various language functions , and this effect is accompanied by a significant increase of task-related flow activation in eloquent areas of the left hemisphere Studies of 60 dyslexic boys age 8 - 14 , carefully selected for exclusion of intellectual , sensory , psychiatric and neurological impairment and educational deprivation , were conducted to determine the efficacy of Piracetam , over a 12-week period , in improving reading and other related skills . There were no changes at the end of 12 weeks to distinguish the groups in accuracy or comprehension of prose-reading . Short-term memory gains , however , were recorded for the treated group on two different tests ,  digit span  , and a test ( Neimark ) of immediate and delayed recall . The mean digit span scaled score for the entire group was one S.D. below their mean IQ . Considering only the performance of children whose digit span scaled scores were one S.D. or below the mean ( 7 or less ) , the treated group made a significant gain at the end of 12 weeks . On the Neimark test the treated group was significantly superior to the untreated group on first trial learning and they also lost significantly fewer object names after a delay . Improved retrieval from long-term storage could be demonstrated for the treated group on the rapid automatized naming test . Although there was no significant difference between the group at screening , the treated group was significantly faster on letter naming at the end of the drug trial . The treated group also improved their single word reading on the WRAT Piracetam , a new class of drug ( nootropil ) thought to enhance specific cognitive skills , was given in a 3300 mg daily dose to half of a group of fifty-five dyslexic boys aged 8 - 13 years , in a 12-week , double-blind , placebo-controlled study . The other half of the subjects received placebo .  All subjects met the following criteria : normal intelligence , normal educational opportunities , no severe emotional problems , no neurological h and icaps , good physical health , not taking other psychotropic medication , and scoring at least one and one half years below their mental age equivalent on the Gilmore Oral Reading Test .  Non-verbal ( auditory and visual ) and verbal perceptual , and memory skills were examined , and reading , spelling , language and writing abilities were measured using st and ardized instruments . Compared to the placebo control group , individuals treated with Piracetam did not show statistically significant improvements above their baseline scores on measures of perception , memory , language , reading accuracy or comprehension , or writing accuracy . However , reading speed and numbers of words written in a timed period were significantly enhanced in subjects treated with Piracetam as compared to placebo .  Effective reading and writing ability , taking both rate and accuracy into consideration , were also significantly improved in the Piracetam as compared to the placebo treatment group . The medication was well-tolerated and medical examinations showed no significant adverse reactions . These results encourage further study of Piracetam to determine more precisely the mechanism of action by which specific cognitive skills are affected Knowledge of the frequency and remission of aphasia is essential for the rehabilitation of stroke patients and provides insight into the brain organization of language . We studied prospect ively and consecutively an unselected and community‐based sample of 881 patients with acute stroke .  Assessment of aphasia  was done at admission , weekly during the hospital stay , and at a 6‐months follow‐up using the aphasia score of the Sc and inavian Stroke Scale .  Thirty‐eight percent had aphasia at the time of admission ; at discharge 18 % had aphasia .  Sex was not a determinant of aphasia in stroke , and no sex difference in the anterior‐posterior distribution of lesions was found . The remission curve was steep : Stationary language function in 95 % was reached within 2 weeks in those with initial mild aphasia , within 6 weeks in those with moderate , and within 10 weeks in those with severe aphasia . A valid prognosis of aphasia could be made within 1 to 4 weeks after the stroke depending on the initial severity of aphasia . Initial severity of aphasia was the only clinical ly relevant predictor of aphasia outcome . Sex , h and edness , and side of stroke lesion were not independent outcome predictors , and the influence of age was minimal Aphasia causes significant disability and h and icap among stroke survivors . Language therapy is recommended for aphasic patients , but not always available . Piracetam , an old drug with novel properties , has been shown to have mild beneficial effects on post-stroke aphasia . In the current study , we investigated the effects of 6 months treatment with piracetam on aphasia following stroke . Thirty patients with first-ever ischemic strokes and related aphasia were enrolled in the study . The scores for the National Institutes of Health Stroke Scale ( NIHSS ) , Barthel Index ( BI ) , modified Rankin Scale ( mRS ) , and Gülhane Aphasia Test were recorded . The patients were scheduled r and omly to receive either 4.8 g piracetam daily or placebo treatment for 6 months . At the end of 24 weeks , clinical assessment s and aphasia tests were repeated . The level of improvement in the clinical parameters and aphasia scores was compared between the two groups . All patients had large lesions and severe aphasia . No significant difference was observed between the piracetam and placebo groups regarding the improvements in the NIHSS , BI and mRS scores at the end of the treatment . The improvements observed in spontaneous speech , reading fluency , auditory comprehension , reading comprehension , repetition , and naming were not significantly different in the piracetam and placebo groups , the difference reached significance only for auditory comprehension in favor of piracetam at the end of the treatment . Piracetam is well-tolerated in patients with post-stroke aphasia .  Piracetam taken orally in a daily dose of 4.8 g for 6 months has no clear beneficial effect on post-stroke language disorders Summary : The nootropic agent piracetam has been shown to improve learning and memory , and it may , by this means , facilitate recovery and rehabilitation after a stroke . We report the results of a pilot study exploring its effects in patients undergoing rehabilitation after acute cerebral infa rct ion in the carotid artery territory . We compared piracetam and placebo , each given for 12 weeks , in a multicenter , double-blind , r and omized trial of parallel-group design ; testing was performed at baseline ( 6–9 weeks poststroke ) , weeks 5 and 12 , and , in fewer patients , 12 weeks after termination of treatment . St and ardized tests of activities of daily living ( Barthel Index , Kuriansky Test ) , aphasia ( Aachen Aphasia Test ) , and perception ( Rivermead Perception Assessment Battery ) were the primary efficacy variables . Of 158 patients , 137 ( 81 males , 56 females ) were studied after treatment and 88 at 24-week follow-up . Thirty patients on piracetam ( 45 % ) and 37 on placebo ( 53 % ) were aphasic on entry . Both groups , including the subgroups with aphasia , were well matched at baseline for demographic data , stroke sequelae , type and severity of aphasia , and prognostic parameters . Multivariate analysis of Aachen Aphasia subtest scores showed a significant overall improvement relative to baseline in favor of piracetam ( p = 0.02 ) at 12 weeks . This was not seen at 24 weeks when , however , fewer patients were available for evaluation so that we could neither confirm nor deny whether improvement was maintained after cessation of piracetam . We were unable to demonstrate an effect on tests of activities of daily living and could neither confirm nor exclude an effect on perceptual deficit . We have shown an improvement in aphasia in patients undergoing rehabilitation after a stroke after 12 weeks ' treatment with piracetam that requires confirmation in further studies BACKGROUND People search medline for trials of healthcare interventions for clinical decisions , or to produce systematic review s , practice guidelines , or technology assessment s. Finding all relevant r and omized controlled trials ( RCTs ) with little extraneous material is challenging . OBJECTIVE To provide comparative data on the operating characteristics of search filters design ed to retrieve RCTs from medline . METHODS We identified 38 filters . The testing data base comprises h and search ing data from 161 clinical journals indexed in medline .  Sensitivity , specificity and precision were calculated . RESULTS The number of terms and operating characteristics varied considerably . Comparing the retrieval against the single term ' r and omized controlled trials.pt . ' ( sensitivity for retrieving RCTs , 93.7 % ) , 24 of 38 filters had statistically higher sensitivity ; 6 had a sensitivity of at least 99.0 % . Four other filters had specificities ( non retrieval of non- RCTs ) that were statistically not different or better than the single term ( 97.6 % ) . Precision was poor : only two filters had precision ( proportion of retrieved articles that were RCTs ) statistically similar to that of the single term (56.4%)-all others were lower . Filters with more search terms often had lower specificity , especially at high sensitivities . CONCLUSION Many RCT filters exist ( n = 38 ) . These comparative data can direct the choice of an RCT filter Forty children with dyslexia , aged 7 - 12 years , have been r and omized into two groups in an open controlled study : 18 of them received Nootropil ( piracetam ) in the dose of 100 mg/kg daily for 2 months and 22 were examined as a control group .  Nootropil exerted positive effects on reading and spelling skills in 56 % of children with dyslexia who demonstrated the improvement of fluency and accuracy of reading along with a significant decrease of specific errors ( dysphonemic and visuospatial ) in dictation . In the control group , the improvement was seen only in 10 % of children . These data corresponded to the results of neuropsychological testing that demonstrated the improvement of automatic lexical retrieval , phonological skills and sustained attention in dyslexic children treated with nootropil as compared to the control group . The dynamics of interhemispheric asymmetry in EEG alpha-theta-subb and s ( 4 - 13 Hz ) during the performance of incomplete figures recognition test in the nootropil treatment may be indicative of the formation of compensative mechanisms linked with the functional activation of the right hemisphere structures and associative anterior left hemisphere areas which contributed to the progress in reading and spelling skills BACKGROUND AND PURPOSE Piracetam , a nootropic agent with neuroprotective properties , has been reported in pilot studies to increase compromised regional cerebral blood flow in patients with acute stroke and , given soon after onset , to improve clinical outcome . We performed a multicenter , r and omized , double-blind trial to test whether piracetam conferred benefit when given within 12 hours of the onset of acute ischemic stroke to a large group of patients . METHODS Patients received placebo or 12 g piracetam as an initial intravenous bolus , 12 g daily for 4 weeks and 4.8 g daily for 8 weeks . The primary end point was neurologic outcome after 4 weeks as assessed by the Orgogozo scale . Functional status at 12 weeks as measured by the Barthel Index was the major secondary outcome . CT scan was performed within 24 hours of the onset of stroke but not necessarily before treatment . Analyses based on the intention to treat were performed in all r and omized patients ( n = 927 ) and in an " early treatment " population specified in the protocol as treatment within 6 hours of the onset of stroke but subsequently redefined as less than 7 hours after onset ( n = 452 ) . RESULTS In the total population , outcome was similar with both treatments ( the mean Orgogozo scale after 4 weeks : piracetam 57.7 , placebo 57.6 ; the mean Barthel Index after 12 weeks : piracetam 55.8 , placebo 53.1 ) . Mortality at 12 weeks was 23.9 % ( 111/464 ) in the piracetam group and 19.2 % ( 89/463 ) in the placebo group ( relative risk 1.24 , 95 % confidence interval , 0.97 to 1.59 ; P = .15 ) . Deaths were fewer in the piracetam group in those patients in the intention-to-treat population admitted with primary hemorrhagic stroke . Post hoc analyses in the early treatment subgroup showed differences favoring piracetam relative to placebo in mean Orgogozo scale scores after 4 weeks ( piracetam 60.4 , placebo 54.9 ; P = .07 ) and Barthel Index scores at 12 weeks ( piracetam 58.6 , placebo 49.4 ; P = .02 ) . Additional analyses within this subgroup , confined to 360 patients with moderate and severe stroke ( initial Orgogozo scale score < 55 ) , showed significant improvement on piracetam in both outcomes ( P < .02 ) . CONCLUSIONS Piracetam did not influence outcome when given within 12 hours of the onset of acute ischemic stroke . Post hoc analyses suggest that piracetam may confer benefit when given within 7 hours of onset , particularly in patients with stroke of moderate and severe degree . A r and omized , placebo-controlled , multicenter study , the Piracetam Acute Stroke Study II ( PASS II ) will soon begin Aphasia , depression , and cognitive dysfunction are common consequences of stroke , but knowledge of their interrelationship is limited . This 1-year prospect i ve study was design ed to evaluate prevalence and course of post-stroke aphasia and to study its psychiatric , neurological , and cognitive correlates . We studied a series of 106 consecutive patients ( 46 women and 60 men , mean age 65.8 years ) with first-ever ischaemic brain infa rct ion . The patients were clinical ly examined , and presence and type of aphasia were evaluated during the 1st week after stroke and 3 and 12 months later . Psychiatric and neuropsychological evaluations were performed 3 and 12 months after stroke . Aphasia was diagnosed in 34 % of the patients during the acute phase , and two thirds of them remained so 12 months later . Seventy percent of the aphasic patients fulfilled the DSM-III-R criteria of depression 3 months and 62 % 12 months after stroke . The prevalence of major depression increased from 11 to 33 % during the 12-month follow-up period . The non-verbal neuropsychological test performance in the aphasic patients was significantly inferior to that of the patients with dominant hemisphere lesion without aphasia . One third of the patients with ischaemic stroke suffer from communicative disorders which seem to increase the risk of depression and non-verbal cognitive deficits . Although the prevalence of depression in aphasic patients decreases in the long term , the proportion of patients suffering from major depression seems to increase . We emphasize the importance of the multidimensional evaluation of aphasic stroke patients OBJECTIVE To determine whether piracetam 4.8 g/day together with intensive language therapy improved language function more than language therapy alone . DESIGN Double-blind , placebo-controlled parallel group study . SETTING Referral speech and language clinic of a university department of neurology . PATIENTS Sixty-six in patients with aphasia present between 4 weeks and 36 months . INTERVENTIONS Intensive language therapy for 6 weeks in all patients . Thirty-two patients received piracetam 4.8 g daily and 34 patients received placebo . MAIN OUTCOME MEASURE The Aachen Aphasia Test ( AAT ) , a st and ardized procedure for evaluating the severity of aphasia , was performed at baseline and after 6 weeks ' treatment . RESULTS In 50 patients evaluated for efficacy , a trend toward improvement in the active group was observed in all subtests of the AAT . This trend was statistically significant for absolute differences in recovery of " written language " and " profile level . " CONCLUSION Piracetam appears to have a positive adjuvant effect on the recovery of aphasia in patients receiving intensive language therapy Previous research has suggested that dyslexics treated with piracetam have shown improvements in reading skills , verbal memory and verbal conceptualizing ability , feature analysis , and processing of letter-like stimuli .  Two hundrend twenty-five dyslexic children between the ages of 7 years 6 months and 12 years 11 months whose reading skills were significantly below their intellecutual capacity were enrolled in a multicenter , 36-week , double-blind , placebo-contrlled study . Children of below average intelligence , with abnormal findings on audiologic , ophthalmologic , neurologic , psychiatric , and physical examinations , who were emotionally disturbed or educationally deprived and who had recently been treated with psychoactive medication were excluded from the trial .  Piracetam was well tolerated , with no serious adverse clinical or laboratory effects reported . Piracetam-treated children showed significant improvements in reading ability ( Gray Oral Reading Test ) and reading comprehension ( Gilmore Oral Reading Test ) . Treatment effects were evident after 12 weeks and were sustained for the total period ( 36 weeks OBJECTIVE Electroencephalographic and clinical effects of piracetam in post-stroke aphasia were evaluated in a prospect i ve , r and omized , double-blind , placebo-controlled trial . METHODS In 24 patients with mild to moderate aphasia after ischemic stroke , quantitative topographic EEG at rest was studied before and after a 6-week treatment period . RESULTS In the active treatment group , a significant shift in the alpha-rhythm from frontal to occipital regions was observed which may be due to a restitution of corticothalamic circuits involved in the generation of alpha-activity . CONCLUSION Neuropsychological scores improved significantly and markedly in various domains of speech during piracetam treatment , whereas improvements were less marked and restricted to a few categories in the placebo group Nootropyl ( Piracetam ) a drug reported to facilitate learning in animals was tested for its effect on man by administering it to normal volunteers . The subjects were given 3 × 4 capsules at 400 mg per day , in a double blind study . Each subject learned series of words presented as stimuli upon a memory drum . No effects were observed after 7 days but after 14 days verbal learning had significantly increased
target: Conclusions Piracetam plays a limited role in the rehabilitation of overall language impairment and only benefits written language ability at the end of trials .
  Its effect on overall linguistic level and written language tends to emerge within a short period and declines thereafter
background: Background Aphasia is a common symptom in post-stroke patients .
  Piracetam is a commonly used nootropic agent that promises various benefits to brain function , including language improvement .
  Objective We performed a systematic review and meta- analysis to assess whether piracetam facilitates the rehabilitation of language performance in post-stroke patients .