Abstract Background Nonfluent aphasia after ischemic stroke severely limits communication, and recovery with standard speech and language therapy (SLT) is often incomplete. Neurotrophic agents such as Cerebrolysin may enhance neuroplasticity, but evidence specific to aphasia has been limited. This meta-analysis integrates results from the ESCAS trial with previous randomized controlled trials (RCTs) evaluating Cerebrolysin’s effects on language recovery. Methods RCTs published between 2000–2024 were identified in PubMed, Cochrane, and Embase using terms related to Cerebrolysin and aphasia. Inclusion criteria required adult post-ischemic stroke populations, Cerebrolysin intervention, and language outcome measures. Three studies met criteria: the ESCAS trial (n=123), Jianu et al. (2010), and an aphasia subgroup from Bornstein et al. (2018). Standardized mean differences (Cohen’s d) were pooled using a random-effects model. Results Across trials, Cerebrolysin combined with SLT produced significantly greater improvements in Western Aphasia Battery–Aphasia Quotient (WAB-AQ) at 90 days. ESCAS reported a +14.8-point mean difference versus placebo. Pooled effect size for language recovery was large (d=0.94; I2=21%). Secondary outcomes also favored Cerebrolysin: NIH Stroke Scale improvement (d=0.74), Barthel Index gains (d=0.56), and a positive trend in modified Rankin Scale scores (d=0.43). Safety profiles were comparable to placebo. Conclusion Evidence from three RCTs—including the robust ESCAS trial—supports Cerebrolysin as an effective adjunct to SLT for nonfluent aphasia after ischemic stroke. Benefits extend beyond language to overall neurological and functional recovery. Larger multicenter trials with longer follow-up are warranted to confirm long-term efficacy and refine treatment protocols. Conflict of interest HSIU KUEI CHEN:nothing to disclose
Chen et al. (Fri,) studied this question.
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