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Correlation between CSWS and aphasia in Landau-Kleffner syndrome: a study of three cases.

We report three typical cases of Landau-Kleffner syndrome with varied courses. The very frequent discharges in sleep EEGs, often showing the patterns of CSWS (continuous spike-waves during slow-wave sleep), either typical (spike-wave complex occupying over 85% of slow-wave sleep duration) or atypical (spike-waves occupying less than 85% of slow-wave sleep), were presented in all our cases. The CSWS seems correlated with aphasia in our cases. Since the disappearance of CSWS might be indicative of a lagged improvement in aphasia, we suggest that sufficiently long-term treatment with anticonvulsants and/or corticosteroids is worthwhile, if the EEG is improved significantly by this treatment.

Anticonvulsants↗

Noun and verb processing in Greek-English bilingual individuals with anomic aphasia and the effect of instrumentality and verb-noun name relation.

Noun and verb comprehension and production was investigated in two groups of late bilingual, Greek-English speakers: individuals with anomic aphasia and a control group of non-brain injured individuals matched for age and gender. There were no significant differences in verb or noun comprehension between the two groups in either language. However, verb and noun production during picture naming was significantly worse in the bilingual individuals with anomic aphasia in both languages, who also showed a specific verb impairment in Greek and English. The potential underlying level of breakdown of the specific verb impairment was further investigation with reference to two specific features of verbs: instrumentality and verb-noun relationship. Additional results revealed a facilitatory effect of Instrumentality in both languages. However, there was no effect of verb-noun name relation in Greek, and a negative effect of verb-noun name relation was observed in English. Lemma retrieval seemed to be intact in this group of bilingual individuals whose main problem seemed to arise during the retrieval of the phonological representation of the target word. This impairment was greater in English. The findings are discussed in terms of three current models of word production.

Aged↗

Neural recruitment associated with anomia treatment in aphasia.

The purpose of this study was to investigate changes in the spatial distribution of cortical activity associated with anomia treatment in three persons with aphasia. Participants underwent three fMRI sessions before and after a period of intensive language treatment focused on object naming. The results revealed bilateral hemispheric recruitment associated with improved ability to name items targeted in treatment. This is the first study to employ multiple pre- and post-treatment fMRI sessions in the study of treatment-induced recovery from aphasia and has implications for future studies of brain plasticity in stroke.

Aged↗

Syndromes of acquired epileptic aphasia and epilepsy with continuous spike-waves during sleep: models for prolonged cognitive impairment of epileptic origin.

Neuropsychological deficits are the common "hallmark" of acquired epileptic aphasia and epilepsy with continuous spike-waves during sleep. Findings from various sources (eg, clinical cases, electrophysiological and positron emission tomography studies) indicate that the aphasia or the behavioral and intellectual deterioration are closely linked to a particular sustained focal epileptic activity. This leads to a wider concept of prolonged cognitive impairment of epileptic origin.

Age of Onset↗

Acquired epileptiform aphasia.

The acquired epileptiform aphasias, with Landau-Kleffner's syndrome as the example, represent an important group of syndromes in our quest to understand the relationship between epilepsy, language, and behavior. The controversy that truly frames the literature on the acquired epileptiform aphasias is the role of epileptiform activity on language, behavior, and cognition. This review expands the model of Landau-Kleffner's syndrome to include two other encephalopathies with language and behavioral regression in association with an epileptiform electroencephalogram. Both of these encephalopathies, autistic epileptiform regression and disintegrative epileptiform regression, are associated with an acquired language disorder. The developmental period in which the acquired language disorder begins, the type of language disorder, and the location and type of the epileptiform activity are all important variables that may affect clinical manifestations and prognosis.

Child↗

Effects of treatment for sound errors in apraxia of speech and aphasia.

This investigation was designed to examine the acquisition, generalization, and maintenance effects of a treatment for sound errors in speakers with co-occurring apraxia of speech and aphasia. Three speakers with chronic apraxia of speech and aphasia were studied in the context of a multiple baseline design across speakers and behaviors. Treatment combined the use of minimal contrast pairs with traditional sound production training techniques such as integral stimulation and articulatory placement cueing and was applied sequentially to sounds that were determined to be consistently in error before training. Results revealed increased correct sound productions for all speakers in trained and untrained words. Response generalization effects across sounds and stimulus generalization effects varied, but appeared to be limited for most speakers. Although positive maintenance effects were evidenced, some loss of treatment gains was noted following cessation of treatment.

Apraxias↗

Aphasia or dementia: the cautionary tale of Dr. JJ.

This case study involves the differential diagnosis of aphasia versus dementia. However, the case of Dr. JJ is instructive from a number of aspects, presented here as "cautionary notes" which are intended to remind clinicians of sometimes-forgotten interpersonal issues in the diagnosis of disorders of speech and language. This case also is intended to illustrate that merely distinguishing between dementia and aphasia is sometimes inadequate, particularly when potentially transmittable (and in some cases, curable) dementias might be involved.

Aged↗

Quantitative assessment of impairment in constructional ability by cube copying in patients with aphasia.

Constructional apraxia was evaluated in patients with aphasia using a cube-copying task. It was assessed whether quantitative assessment of cube copying could be used to estimate the performance intelligence quotient (IQ) according to neuropsychological tests. Abnormality in the cube-copying test was observed in 42 of 46 patients (91.3%). Performance according to Raven's coloured progressive matrices and the revised Wechshler adult intelligence scale (WAIS-R) in patients with poor cube copying was significantly lower than in the other four patients. Numbers of the connections completed and plane-orientation errors made in the cube-copying test were significantly correlated with performance IQ on the WAIS-R, correlating particularly with block design, digit symbol, and object assembly in performance IQ subtests. The quantitatively scored cube-copying test, then, can roughly predict non-verbal IQ in patients with aphasia.

Adult↗

A chance SPECT study of ictal aphasia during simple partial seizures.

We report obtaining an ictal single photon emission computed tomographic (SPECT) scan in a right-handed 51-year-old man who had an astrocytoma in the left cerebral hemisphere and simple partial seizures characterized by aphasia. An epileptic seizure producing loss of speech and right-sided facial twitching occurred by chance during a SPECT scan. During the attack, he was unable to speak, but auditory comprehension and writing were intact. Ictal SPECT showed an area of increased perfusion in the left frontal cortex, with the area of highest perfusion involving the left frontal operculum to the inferior part of the left precentral gyrus. Interictal SPECT showed hypoperfusion in the same area. These SPECT findings suggest that the frontal operculum of the dominant hemisphere is one of the regions that can give rise to epileptic aphasia.

Astrocytoma↗

Anomic aphasia in childhood.

Documented cases of anomic aphasia in childhood are rare, due to their low prevalence and relatively subtle clinical manifestations and because of probable referral bias. Such cases are important, however, because they may shed light on the nature of lesions that produce anomia in children and because they may contribute to our understanding of brain-behavior relations in children. This case involves a 10-year-old girl who experienced a left temporoparietal hematoma. Recovery over an 8-month period was good, with near normal verbal-expressive (Verbal IQ = 86) and normal perceptual-motor abilities (Performance IQ = 100). Reading, spelling, and repetition were preserved. Spontaneous speech was good, although initially circumlocutory and marked by obvious word-finding difficulty. Consistent with reports involving adults, there was significant disturbance in naming characterized by frequent literal and semantic paraphasias. Although she had significant difficulty on confrontational naming, she could accurately spell and read the name of the objects presented to her. This case is discussed relative to localization of lesions producing anomic aphasia and regarding the course of recovery in childhood.

Anomia↗

A case of foreign accent syndrome without aphasia caused by a lesion of the left precentral gyrus.

We report a case of foreign accent syndrome (FAS) without aphasia. The patient was a right-handed, 44-year-old woman, a native Japanese. Disposition and inversion of pitch accents and appearance of unnecessary stress accents made her speech sound foreign, like that of a Korean. MRI demonstrated an infarction in the middle fifth of the posterior lateral aspect of the left precentral gyrus. Limited motor cortex damage causes FAS without dysarthria, apraxia of speech, or aphasia.

Adult↗

[Landau-Kleffner syndrome (acquired epileptic aphasia)].

Landau-Kleffner syndrome is characterized by a complex group of symptoms including deterioration in language skills, seizures, and abnormal electroencephalography findings. A six-year-old male patient had aphasia for three years and generalized tonic-clonic epileptic seizures for two years. Pure-tone audiometry and auditory brain-stem response audiometry findings were normal. He had verbal auditory agnosia rather than true aphasia. Cranial computed tomography and magnetic resonance imaging studies did not show any abnormal findings. Single-photon emission computed tomography showed hypoperfusion in the right hemispheric temporal lobe. Despite treatment with corticosteroids and intravenous immunoglobulins, multiple exacerbations were interspersed in a four-year follow-up period.

Agnosia↗

Rapid recovery from crossed aphasia in a dextral.

A case of crossed aphasia in a right-handed woman resulting from a right-hemisphere stroke is reported. Rapid recovery occurred between an initial evaluation performed at one month poststroke and a follow-up evaluation performed at 2 months post. The cerebral organization and the relationship between language and other cognitive abilities in crossed aphasics are discussed. Additionally, the unitary and transient models of crossed aphasia are examined.

Journal Article↗

[Landau-Kleffner syndrome (acquired aphasia with epilepsy). Etiopathology and response to treatment with anticonvulsants].

The Landau-Kleffner syndrome consists in the association of an aphasia acquired during childhood or adolescence after a period of normal development, accompanied by epileptic fits and, sometimes, psychological disturbances. The appearance of the symptoms may not be simultaneous. The nature of this syndrome has been widely discussed and even the possibility of being a non-unitary syndrome has been considered. It may be possibly due to diverse etiologies, genetic or acquired (infectious). The relation between the aphasic, the psychologic and the convulsive symptoms has also raised controversies. A case of a female is described in which the psychological symptomatology was so severe, she had to be admitted in a psychiatric unit. The symptoms consisted in agitation during the night and severe persistent insomnia so as difficulties for relationship during day. No abnormalities were detected in a TAC nor in a RM but electroencephalographic and neuropsychological abnormalities were detected. The epileptic fits disappeared with a carbamacepine treatment but the rest of symptoms remained even more accentuated. After her admission, a treatment with valproate achieved to control her fits and the aphasic symptoms and neuropsychological deficits were compensated in the course of several months. After a year of treatment the patient's life was normalized, she resumed her studies, the EEG abnormalities disappeared so as the psychological disturbances and the behavior problems with the exception of phobic symptoms, similar to the ones of other family members. The patient has a history of epilepsy on its mother's side. The evolution and treatment response suggests that at least in some cases of the Landau-Kleffner syndrome, the etiology of the aphasia and other neuropsychological deficits and of the behavior disorders are related with some subclinical epileptic discharges and with a "functional inhibition" of some areas of the nervous system.

Adolescent↗

Cognitive distancing in mediated categorization in aphasia.

Individuals with fluent and nonfluent aphasia and a matched group of aged normal subjects participated in mediated categorization tasks dealing with two levels of cognitive distancing. Moreover, the categorization tasks entailed the utilization of focal and peripheral exemplars. Fluent aphasic subjects had significantly more difficulty than nonfluent aphasic and normal subjects. All subjects had significantly more difficulty with pictures than actual objects. Peripheral exemplars were used less often than focal exemplars. It was spesculated that some of these results may reflect a degenerative process of aging.

Aged↗

Influence of written form on reading comprehension in aphasia.

Reading comprehension of 20 aphasic patients was systematically assessed using equivalent stimuli written in both print and cursive form. A Single-Word-to-Picture Matching task and a Sentence-to-Picture Matching task were employed. Performances of the aphasics were not uniformly facilitated by one written form over the other. Furthermore, the reading comprehension of the majority of individual patients was not influenced by written form. Four of the subjects, however, did appear to display real performance discrepancies when reading cursive versus print, particularly on the Sentence-to-Picture Matching task. Two of these patients performed better when reading cursive, while two performed better when reading print. Reevaluation of two of these patients 6 mo after initial testing revealed that they continued to display the same performance patterns originally demonstrated. Clinical implications of these results for the evaluation and treatment of reading comprehension in aphasia are discussed.

Adult↗

The Language Quotient (LQ): a new measure for the Western Aphasia Battery.

A new summary score, the Language Quotient (LQ), which reflects auditory comprehension, oral expression, reading, and writing performance, is described for the Western Aphasia Battery (WAB). As a summary score of the severity of the language impairment, the LQ is useful to clinicians both for assessment purposes and as an outcome measure to evaluate progress in aphasic patients as treatment proceeds. Reliability and validity of the LQ meet established standards for test construction.

Adult↗

The semantic deficit in aphasia: the relationship between semantic errors in auditory comprehension and picture naming.

Thirty aphasic subjects were asked to point to pictures on auditory command both when the distractors came from the same semantic category as the target and when the distractors were unrelated to the target picture. The aphasics made significantly more semantic errors than non-aphasic brain-damaged controls; the incidence of semantic comprehension errors was unrelated to aphasic diagnostic groups but was related to the overall severity of aphasia. The subjects were subsequently asked to name the pictures from the comprehension task; pictures that had elicited semantic errors in comprehension were no less likely to be named than those that had not, but the incidence of semantic errors in comprehension correlated significantly with their incidence in naming. The implications of a semantic deficit common to both auditory comprehension and naming that is not specific to particular lexical items is discussed in relation to a number of information processing models of the lexicon.

Adolescent↗