This paper presents the case of a 17-year-old right-handed Belgian boy with developmental FAS and comorbid developmental apraxia of speech (DAS). Extensive neuropsychological and neurolinguistic investigations demonstrated a normal IQ but impaired planning (visuo-constructional dyspraxia). A Tc-99m-ECD SPECT revealed a significant hypoperfusion in the prefrontal and medial frontal regions, as well as in the lateral temporal regions. Hypoperfusion in the right cerebellum almost reached significance. It is hypothesized that these clinical findings support the view that FAS and DAS are related phenomena following impairment of the cerebro-cerebellar network.

/pdf/developmental-foreign-accent-syndrome-report-of-a-new-case-2yllsms4ct.pdf

Developmental Foreign Accent Syndrome : Report of a new case

Foreign Accent Syndrome, in het Nederlands ook wel het "buitenlandsaccentsyndroom" genoemd, is een motorische spraakstoornis waardoor patienten hun moedertaal gaan spreken met een accent dat buitenlands klinkt in de oren van luisteraars. In dit proefschrift geven we een duidelijke neurolinguistische beschrijving van drie van de subtypes van het syndroom, namelijk neurogene FAS (die ontstaat na schade aan het centrale zenuwstelsel), FAS op ontwikkelingsbasis en psychogene FAS (FAS in associatie met een psychiatrische stoornis). Op basis van onze analyses, kwamen we tot de conclusie dat 1. de "segmentele" (op niveau van het foneem, een klank die de kleinste distinctieve entiteit vormt) en "suprasegmentele" kenmerken (het niveau boven dat van het foneem, heeft bvb. betrekking op intonatie en ritme) niet volstaan voor eenduidige diagnostische differentiatie tussen de verschillende subtypes: andere (neurologische of psychiatrische) symptomen, evenals symptoomaanvang, evolutie en remissie zijn vaak informatiever in dit opzicht. 2. er mogelijk een vierde variant van FAS bestaat! Bij ons corpusonderzoek vonden we dat FAS ook werd beschreven na kaakchirurgie. We besloten om in dit geval te spreken van een organisch-mechanische FAS. 3. de kleine hersenen (het cerebellum) een niet te onderschatten rol spelen in de pathofysiologie van de aandoening. 4. FAS een stoornis van duale aard is, die zowel kenmerken van een planningsstoornis als executieve stoornis in zich draagt. Eerder werd aangehaald dat FAS een opvallend aantal klinische overeenkomsten vertoont met de spraakapraxie (een planningsstoornis waarbij de patient problemen ondervindt bij het plannen van de klanken en klanksequenties) en de atactische dysartrie (een executieve stoornis waarbij de patient problemen heeft met het uitvoeren van de geplande sequenties via de articulatoren). Toch lijkt de spraak van mensen met voorgaande aandoeningen veel ernstiger verstoord te zijn dan in het geval van FAS. Na een vergelijking van de pathofysiologie en de perceptuele fonetische kenmerken van deze aandoeningen hebben we geconcludeerd dat de overeenkomsten in het klinisch beeld op het neurobiologisch vlak gerelateerd kunnen worden aan (functionele of structurele) schade van de zeer belangrijke cortico-thalamische-striatopallidale verbindingen en voornamelijk de motorische cortex, de insula, de basale ganglia en het cerebellum betreffen.

Foreign Accent Syndrome: A Neurolinguistic Analysis

Few studies addressed the evolution of brain activity before and after brain tumor resection. Using a fMRI naming task, we evaluated possible underlying plasticity phenomena. Thirty-two patients with left low-grade gliomas (16 women; age = 38.6 ± 8.31 years) and 19 healthy controls (7 women; age = 42.4 ± 12.1) were included in the study. An overt picture-naming task (DO80) was performed pre and post (3 months) surgery, as well as within the MRI in a covert manner. Exams included an injected 3DT1, a T2FLAIR, a DTI and a GE-EPI (task) sequence. Activations maps were compared with picture naming score, FA and MD maps were estimated, a VLSM analysis was performed on tumor masks, and disconnectome maps were reconstructed. Pre-surgery, the left parahippocampal gyrus (LPH) was inversely associated with task performance. Increased pre-post surgery left lingual gyrus (LLG) activity was found related to decreased picture naming performance. The evolution of left lingual gyrus (LLG) activity was negatively associated with the evolution of picture naming performance. In controls, the LPH was functionally connected to the right precentral gyrus (RPCG) and slightly to the LLG. This was not clearly retrieved in the patient group. Preoperatively, the LLG was connected to the left planum temporale and to the right lingual gyrus. The same result was found for controls. Postoperatively, the LLG was only connected to the RPCG. No association was found between evolution of FA/MD and evolution of picture naming performance. There is not one unique pattern of pre- and postoperative plasticity concerning picture-naming performance in DLGG patients.

Language reorganization after resection of low-grade gliomas: an fMRI task based connectivity study

Few studies have investigated language recovery patterns and the mechanisms of crossed bilingual aphasia following a subcortical stroke. In particular, Korean-Japanese crossed bilingual aphasia has not been reported. A 47-year-old, right-handed man was diagnosed with an extensive right basal ganglia hemorrhage. He was bilingual, fluent in both Korean and Japanese. After his stroke, the patient presented with crossed aphasia. We investigated changes in the Korean (L1) and Japanese (L2) language recovery patterns. Both Korean and Japanese versions of the Western Aphasia Battery (WAB) were completed one month after the stroke, and functional magnetic resonance imaging (fMRI) was performed using picture-naming tasks. The WAB showed a paradoxical pattern of bilingual aphasia, with an aphasia quotient (AQ) of 32 for Korean and 50.6 for Japanese, with Broca's aphasia. The patient scored better in the Japanese version of all domains of the tests. The fMRI study showed left lateralized activation in both language tasks, especially in the inferior frontal gyrus. After six months of language therapy targeting L1, the Korean-WAB score improved significantly, while the Japanese-WAB score showed slight improvement. In this case, the subcortical lesion contributed to crossed bilingual aphasia more highly affecting L1 due to loss of the cortico-subcortical control mechanism in the dominant hemisphere. The paradoxical pattern of bilingual aphasia disappeared after lengthy language therapy targeting L1, and the therapy effect did not transfer to L2. Language recovery in L1 might have been accomplished by reintegrating language networks, including the contralesional language homologue area in the left hemisphere.

Recovery of language function in Korean-Japanese crossed bilingual aphasia following right basal ganglia hemorrhage.

Foreign Accent Syndrome (FAS) is a motor speech disorder which causes patients to speak their native language with an accent different from speakers belonging to the same language community: the patient lacks the ability to make the phonemic and phonetic contrasts of his/her native language and demonstrates suprasegmental alterations which cause listeners to perceive the accent as distinctly ‘foreign’. In 1982, Whitaker proposed 4 diagnostic criteria for FAS: 1) the accent is considered by the patient, acquaintances and investigators as foreign, 2) it is unlike the patient’s accent before the insult, 3) the accent is clearly related to central nervous system damage, 4) there is no evidence in the patient’s background of him/her being a speaker of a foreign language (pp. 197- 198). Although FAS of “acquired neurogenic origin” is the most common variant of the disorder, there exists a “developmental”, “psychogenic” and “mixed variant” as well (Verhoeven and Marien, 2010).
 
In FAS of neurogenic origin the foreign accent is incited by a lesion affecting the central nervous system, often a stroke or brain trauma. However, FAS has also been attested in relation to MS (Villaverde-Gonzalez et al., 2003), tumor (Masao et al., 2011; Tomasino et al., 2013; Abel et al., 2009), as well as other pathologies affecting the CNS. Developmental FAS can be regarded as a subtype of neurogenic FAS; only here it is developmental in nature, affecting speech as it develops. In the psychogenic variant, a psychological/psychiatric disorder incites FAS, whereas the mixed variant is originally neurogenic in nature, but the accent change has such a profound effect on the patient’s psychological status that he/she internalizes it by further developing the accent in order ‘to create a more “believable” personality’ (Verhoeven and Marien 2010, p. 600)

Foreign accent syndrome: A typological overview

Neural substrate in a case of foreign accent syndrome following basal ganglia hemorrhage

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Neural substrate in a case of foreign accent syndrome following basal ganglia hemorrhage