The neural basis for writing from dictation in the temporoparietal cortex.

Cortical electrical stimulation mapping was used to study neural substrates of the function of writing in the temporoparietal cortex. We identified the sites involved in oral language (sentence reading and naming) and writing from dictation, in order to spare these areas during removal of brain tumours in 30 patients (23 in the left, and 7 in the right hemisphere). Electrostimulation of the cortex impaired writing ability in 62 restricted cortical areas (.25 cm2). These were found in left temporoparietal lobes and were mostly located along the superior temporal gyrus (Brodmann's areas 22 and 42). Stimulation of right temporoparietal lobes in right-handed patients produced no writing impairments. However there was a high variability of location between individuals. Stimulation resulted in combined symptoms (affecting oral language and writing) in fourteen patients, whereas in eight other patients, stimulation-induced pure agraphia symptoms with no oral language disturbance in twelve of the identified areas. Each detected area affected writing in a different way. We detected the various different stages of the auditory-to-motor pathway of writing from dictation: either through comprehension of the dictated sentences (word deafness areas), lexico-semantic retrieval, or phonologic processing. In group analysis, barycentres of all different types of writing interferences reveal a hierarchical functional organization along the superior temporal gyrus from initial word recognition to lexico-semantic and phonologic processes along the ventral and the dorsal comprehension pathways, supporting the previously described auditory-to-motor process. The left posterior Sylvian region supports different aspects of writing function that are extremely specialized and localized, sometimes being segregated in a way that could account for the occurrence of pure agraphia that has long-been described in cases of damage to this region.

Sobre o tratamento de um menino de sete anos: reflexões sobre inibição e angústia / About the treatment of a child who is seven years old: reflections on inhibition and anxiety / Sobre el tratamiento de un niño de siete años: reflexiones sobre inhibición y angustia

Neste artigo, a partir de uma perspectiva psicanalítica, realiza-se uma discussão acerca da evolução clínica do tratamento de um menino de sete anos que apresentava um quadro de inibição da escrita, com o objetivo de evidenciar como, no decorrer do processo de análise, ocorreu uma modificação no que diz respeito ao agenciamento da angústia vivida pelo paciente. Conclui-se que, a partir de certas intervenções pontuais, a angústia inicialmente apresentada pelo paciente diante da falha da função paterna deu lugar à angústia frente ao processo de subjetivação da castração, culminando na assunção de uma tomada de posição na partilha sexual.(AU)

In this article, from a psychoanalytic perspective, conducts a discussion about the clinical treatment of a boy who is seven that presented a case of inhibition of writing, aiming to show how, during the review process, a change has occurred with respect to the assemblage of distress experienced by the patient. We conclude that, from certain specific interventions, the anguish initially presented by the patient before the failure of the paternal role gave way to anguish and subjectivity process of castration, culminating in taking a position on shared sexual.(AU)

En este artículo, a partir de una perspectiva psicoanalítica, se realiza una discusión acerca de la evolución clínica del tratamiento de un niño de siete años que presentaba un cuadro de inhibición de la escrita, con el objetivo de evidenciar como, en el transcurso del proceso de análisis, ocurrió una modificación con relación a la gestión de la angustia vivida por el paciente. Se Concluye que, a partir de ciertas intervenciones puntuales, la angustia inicialmente presentada por el paciente delante de la falla de la función paterna dio lugar a la angustia frente al proceso de subjetividad de la castración, culminando en la asunción de una toma de posición en el reparto sexual.(AU)

Sobre o tratamento de um menino de sete anos: reflexões sobre inibição e angústia / About the treatment of a child who is seven years old: reflections on inhibition and anxiety / Sobre el tratamiento de un niño de siete años: reflexiones sobre inhibición y angustia

Neste artigo, a partir de uma perspectiva psicanalítica, realiza-se uma discussão acerca da evolução clínica do tratamento de um menino de sete anos que apresentava um quadro de inibição da escrita, com o objetivo de evidenciar como, no decorrer do processo de análise, ocorreu uma modificação no que diz respeito ao agenciamento da angústia vivida pelo paciente. Conclui-se que, a partir de certas intervenções pontuais, a angústia inicialmente apresentada pelo paciente diante da falha da função paterna deu lugar à angústia frente ao processo de subjetivação da castração, culminando na assunção de uma tomada de posição na partilha sexual.

In this article, from a psychoanalytic perspective, conducts a discussion about the clinical treatment of a boy who is seven that presented a case of inhibition of writing, aiming to show how, during the review process, a change has occurred with respect to the assemblage of distress experienced by the patient. We conclude that, from certain specific interventions, the anguish initially presented by the patient before the failure of the paternal role gave way to anguish and subjectivity process of castration, culminating in taking a position on shared sexual.

En este artículo, a partir de una perspectiva psicoanalítica, se realiza una discusión acerca de la evolución clínica del tratamiento de un niño de siete años que presentaba un cuadro de inhibición de la escrita, con el objetivo de evidenciar como, en el transcurso del proceso de análisis, ocurrió una modificación con relación a la gestión de la angustia vivida por el paciente. Se Concluye que, a partir de ciertas intervenciones puntuales, la angustia inicialmente presentada por el paciente delante de la falla de la función paterna dio lugar a la angustia frente al proceso de subjetividad de la castración, culminando en la asunción de una toma de posición en el reparto sexual.

Generation of co-speech gestures based on spatial imagery from the right-hemisphere: evidence from split-brain patients.

It has been claimed that the linguistically dominant (left) hemisphere is obligatorily involved in production of spontaneous speech-accompanying gestures (Kimura, 1973a, 1973b; Lavergne and Kimura, 1987). We examined this claim for the gestures that are based on spatial imagery: iconic gestures with observer viewpoint (McNeill, 1992) and abstract deictic gestures (McNeill, et al. 1993). We observed gesture production in three patients with complete section of the corpus callosum in commissurotomy or callosotomy (two with left-hemisphere language, and one with bilaterally represented language) and nine healthy control participants. All three patients produced spatial-imagery gestures with the left-hand as well as with the right-hand. However, unlike healthy controls and the split-brain patient with bilaterally represented language, the two patients with left-hemispheric language dominance coordinated speech and spatial-imagery gestures more poorly in the left-hand than in the right-hand. It is concluded that the linguistically non-dominant (right) hemisphere alone can generate co-speech gestures based on spatial imagery, just as the left-hemisphere can.

Progressive asymmetric apraxic agraphia.

BACKGROUND/OBJECTIVES: Patients with apraxic agraphia cannot correctly form the letters needed to write words but can correctly spell words orally. Apraxic agraphia (AA) is often associated with ideomotor apraxia and most commonly induced by stroke, but can be associated with degenerative diseases. In degenerative diseases, asymmetrical apraxic agraphia (AAA) has rarely been reported as one of the presenting features. The purpose of this report is to describe a case series of 3 patients who presented with an AAA, and also to elucidate some of the cognitive mechanisms of this disorder. METHODS/RESULTS: These patients, who were not aphasic or alexic, developed agraphia as one of their earliest reported symptoms. They also demonstrated an asymmetrical ideomotor apraxia. Their agraphia was characterized by the inability to form letters, with the preserved ability to orally spell. To learn if this disorder was being caused by a loss of spatial-movement representations versus an impairment of implementation, one patient was asked to determine if gestures made by the examiner were correct or incorrect, and also to image the structure of letters. He performed poorly on both these tests and he also demonstrated an asymmetrical agraphesthesia. CONCLUSIONS: These patients' AAA might be the beginning of the corticobasal degeneration syndrome, but future studies will have to examine the brain pathology associated with AAA. Our patient's poor performance on pantomime recognition and imagery suggests that his apraxia is related to a deterioration of his graphemic and transitive spatial movement representations. The recognition of numbers written on the hand with eyes closed might also depend on having intact movement representations and his asymmetrical agraphesthesia might also be related to his AAA.

The purpose of lexical/sublexical interaction during spelling: further evidence from dysgraphia and articulatory suppression.

We investigated how the lexical and sublexical processes interact in spelling using an articulatory suppression task to disrupt the sublexical process in a dysgraphic patient (JDO). Using a similar task, Folk et al. (2002) found evidence that the sublexical process interacts with the lexical process by strengthening a target word's graphemes. We replicated the findings of Folk et al. in a patient with a more severe deficit to the lexical process. We compared the error patterns produced under normal spelling conditions versus spelling during articulatory suppression and found an increase in lexical substitution errors ("thaw"-->T-H-O-U-G-H) under articulatory suppression. These findings indicate that by strengthening a target word's graphemes, the sublexical process helps to create an advantage for a target word over form-related word neighbours that compete with it for output.

Progressive dysgraphia in a case of posterior cortical atrophy.

Dysgraphia (agraphia) is a common feature of posterior cortical atrophy (PCA). However, detailed analyses of these spelling and writing impairments are infrequently conducted. LM is a 59-year-old woman with dysgraphia associated with PCA. She presented with a two-year history of decline in her writing and dressmaking skills. A 3D T1-weighted MRI scan confirmed selective bi-parietal atrophy, with relative sparing of the hippocampi and other cortical regions. Analyses of LM's preserved and impaired spelling abilities indicated mild physical letter distortions and a significant spelling deficit characterised by letter substitutions, insertions, omissions, and transpositions that was systematically sensitive to word length while insensitive to real word versus nonword category, word frequency, regularity, imagery, grammatical class and ambiguity. Our findings suggest a primary graphemic buffer disorder underlies LM's spelling errors, possibly originating from disruption to the operation of a fronto-parietal network implicated in verbal working memory.

Progressive peripheral agraphia.

We describe RW, a patient who presented with writing difficulty that deteriorated over time. While her graphemes were typically legible, her writing was extremely slow, and her letters were written in an inconsistent and heterogeneous manner (e.g. each "a" in the word "banana" was produced in a different way). Her mental imagery of letters was impoverished, and she also produced allographic errors in her writing. She had some spelling errors as well, but many of these were due to omissions, perseverations, and motor operations. A positron emission tomography scan demonstrated superior parietal occipital and superior frontal defects that were more evident on the left than the right. Our observations are consistent with the hypothesis that RW has a deficit retrieving physical letter forms as manifested by her heterogeneous and slow production of letter forms. This disruption of grapheme retrieval is associated with interruption of a superior frontal-parietal system in the left hemisphere.

Pure apraxic agraphia with abnormal writing stroke sequences: report of a Japanese patient with a left superior parietal haemorrhage.

A 67 year old Japanese male patient had pure agraphia after a haemorrhage in the left superior parietal lobule. He developed difficulty in letter formation but showed no linguistic errors, consistent with the criteria of apraxic agraphia. He manifested a selective disorder of sequencing writing strokes, although he was able to orally state the correct sequences. The patient's complete recovery after 1 month, without new learning, showed that he had manifested a selective disorder of writing stroke sequences. These findings indicate that the final stage of the execution of writing according to acquired sequential memory shown as a stroke sequence can be selectively disturbed, and should be considered to be distinct from the ability of character imagery and the knowledge of the writing stroke sequence itself. This case also indicates that the left superior parietal lobule plays an important part in the execution of writing.

Unilateral dysgraphia of the dominant hand in a left-hander: a disruption of graphic motor pattern selection.

This paper reports the case of an English speaking, fully left-handed patient (DS) with a left unilateral writing deficit occurring after a subarachnoid hemorrhage due to the rupture of an anterior communicating aneurysm. DS's performance in spelling and in right-handed writing was entirely preserved while his left-handed writing was characterized by the production of errors which could generally be spontaneously self-corrected. Errors produced with lower-case letters differed from the ones produced with upper-case letters: The former usually corresponded to letter substitutions which were characterized by a high degree of physical similarity between the target letter and the one produced. The latter tended to result in the production of aborted letters. This impairment is discussed in the context of cognitive models of writing. It is suggested that graphic motor patterns for lower-case letters and for upper-case letters are different in nature and consequently that production processes may also differ.

[Spelling impairments. Neuropsychological study in two adolescents with developmental dysgraphia]. / Trouble de l'apprentissage de l'orthographe. Etude neuropsychologique de deux adolescents présentant une dysgraphie développementale.

Two adolescents 14 and 16 years of age presented with isolated developmental agraphia. The spelling errors were correlated with the degree of orthographic ambiguity and with the word frequency as in acquired agraphia. Patients used to simplify the words spelling and to follow the phoneme-grapheme conversion. The deficit is interpreted as a failure of a selective visual memory for irregular words, representing a developmental graphemic logogene impairment. The better performance of reading is interpreted in relation to phonological system integrity which could better supply the grapheme phoneme conversion of reading even for irregular words. The ambiguous and irregular words recognition during reading appeared easier than their spelling during writing. Short term and working memory for irregular words appeared normal; the deficit occurred only for the long term recall after 20 minutes. Learning of 20 irregular words was made possible in one case by selective reminding of the errors. In spite of normal MRI, a developmental disorder involving the angular gyrus is proposed as for acquired lexical agraphia in adults.

Pure agraphia and Gerstmann's syndrome as a visuospatial-language dissociation: an experimental case study.

A right-handed man suffered a left parieto-occipital cerebral infarction, causing agraphia with Gerstmann's syndrome but without major aphasia, alexia, or apraxia. Oral spelling was superior to written spelling. Experiments were performed involving (1) analysis of errors in writing, (2) tasks of visual imagery, and (3) identifying letters drawn without leaving a visual trace. The results suggest that the agraphia and Gerstmann's syndrome are due to a dissociation of language skills and visuospatial skills caused by a dominant parieto-occipital lesion.

Letter imagery deficits in a case of pure apraxic agraphia.

Pure apraxic agraphia is a condition in which motor writing is impaired but limb praxis and nonmotor writing (typing, anagram letters) are preserved. This condition is believed to result from disruption of a parietal lobe graphemic area which generates grapheme representations used to program motor-writing patterns. We report a single case of pure apraxic agraphia in which defective letter imagery was evident. Results of writing and imagery evaluations suggest that the graphemic area may be responsible for generating letter images. In this respect, clinical evaluation of letter imagery abilities in cases of apraxic agraphia may be useful in identifying subtypes of the disorder resulting in a better understanding of the neuropsychological process involved in writing.