Treatment-Induced Recovery Patterns Between Nouns and Verbs in Mandarin-English Bilingual Adults With Aphasia.

PURPOSE: This study aimed to investigate treatment effects of naming therapy targeting nouns and verbs in Mandarin-English bilingual adults with aphasia (BWA). METHOD: Twelve Mandarin-English bilingual adults with chronic aphasia completed a 40-hr semantic-based naming treatment for either nouns or verbs. Eight of these participants completed both noun and verb treatment, and the other four completed either noun or verb treatment. Participants were trained in either Mandarin or English for both treatment cycles. Weekly naming probes were measured to capture the direct treatment gain and within- and cross-language generalizations. Performance on the standardized language assessments was analyzed to examine further generalizations beyond the word level and to standardized naming tasks. RESULTS: Responses in the weekly naming probes showed significant treatment gains in both noun and verb treatment, but the effect was greater in verb treatment. Generalization to semantically related items was captured in noun treatment only. Cross-language generalization was identified in both noun and verb treatment with a larger effect in verb treatment. Additionally, widespread generalizations beyond the word level and to standardized naming tasks were found following both noun and verb treatment, but the effect was larger following noun treatment in discourse and verb naming tasks. CONCLUSIONS: Findings from this study suggested robust treatment effects of semantic-based naming treatment targeting nouns and verbs in Mandarin-English BWA. However, patterns of treatment gains and generalizations differed between these word categories. This study provides strong evidence of bilingual aphasia rehabilitation in Mandarin-English BWA. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23818299.

Prognostication in post-stroke aphasia: speech pathologists' clinical insights on formulating and delivering information about recovery.

PURPOSE: For people with post-stroke aphasia, "Will I get better?" is a question often asked, but one that is intellectually and emotionally demanding for speech pathologists to answer. Speech pathologists' formulation and delivery of aphasia prognoses is varied and there is limited evidence for optimising practice. We aimed to understand speech pathologists' clinical experiences, reasoning, and support needs in aphasia prognostication. MATERIALS AND METHODS: Twenty-five Australian speech pathologists working with people with aphasia participated in individual, semi-structured interviews. Their age, level of experience, work setting, and location were maximally varied. Interview responses were analysed qualitatively using thematic analysis. RESULTS: Five themes were drawn from the interviews: (1) prognostic challenges are shared but not voiced; (2) truth is there's no quick fix; (3) recovery is more than words; (4) the power of words; and, (5) prognostic competence is implicit. CONCLUSIONS: Speech pathologists use implicit competencies to formulate and deliver aphasia prognoses. A patient-centred, holistic contextualisation of aphasia recovery may enable realistic, optimistic, and constructive conversations about prognosis. These conversations may have therapeutic potential if prognostic uncertainty, emotional adjustment, and conditional outcomes are carefully addressed. Future research should seek to understand the perceptions and preferences of people with aphasia and their significant others.Implications for RehabilitationAphasia prognostication in clinical practice is complex and nuanced, thus increased clinical and research focus is warranted to ensure key stakeholder needs are met.Conversations about prognosis may be more meaningful to people with aphasia if recovery is conceptualised as encompassing impairment, activity, and participation outcomes.Given the implicit competencies required for prognostication, a structured approach to reflective practice and experience-based training may be beneficial.Conversations about prognosis may have therapeutic value, but further research is needed to explore this potential.

Assessing Self-Reported Mood in Aphasia Following Stroke: Challenges, Innovations and Future Directions.

Assessment of mood is critical in determining rehabilitation outcomes for stroke and other acquired brain injury, yet a common consequence of such injuries is aphasia, where language is impaired. Consequently, the use of language-based measures in this population is often not possible. Following a critical review of the neuropsychological aspects of self-reported mood, this paper evaluates the problems in reporting mood after stroke due to aphasia, and discusses implications for the design of adapted instruments. The paper then appraises the construction and psychometric properties of existing, adapted self-report measures developed to try and address these problems, and evaluates their utility and limitations. This includes a focus on the recently validated tablet-based Dynamic Visual Analog Mood Scales (D-VAMS), which uses innovative non-verbal assessment methods based on facial expression modulated via a slider control on a touchscreen interface. Currently, most studies evaluating recovery interventions simply omit individuals with aphasia because of the difficulty of assessing mood and quality of life in this population. However, adapted scales such as the D-VAMS appear to represent an important step forward in assessing mood in people with language impairments, with the use of interactive modulated imagery having wider applications for nonverbal communication as well as the quantification of subjective phenomena.

The impact of the telerehabilitation group aphasia intervention and networking programme on communication, participation, and quality of life in people with aphasia.

Purpose: Aphasia group therapy can result in improvements in communication, participation and quality of life (QOL). However, evidence for aphasia group interventions with combined aims across the International Classification of Functioning, Disability and Health (ICF) is limited. TeleGAIN is a holistic aphasia group intervention that can be delivered via telepractice. This study builds on prior pilot work and addresses the need for additional research into the effectiveness of TeleGAIN. The aim of this study was to describe changes in aphasia severity, communication related QOL and participation, for people with chronic aphasia following TeleGAIN. Method: Nineteen participants with aphasia were assessed on a range of outcome measures before and after a twelve-week block of TeleGAIN delivered via web based videoconferencing. Treatment provided opportunities to participate in conversation, engage with others with aphasia and complete functional communication activities. Result: Statistical analyses revealed statistically significant improvements in communication related QOL, increased engagement in communicative activities, and decreased aphasia severity. Conclusion: Results from this study suggest that the online delivery of a multi-purpose group intervention for people with aphasia can result in improved communication, communicative participation, and QOL. It also highlights the potential for intervention provided via telepractice to offer an alternative to face-to-face services.

The Nature of Error Consistency in Individuals With Acquired Apraxia of Speech and Aphasia.

PURPOSE: The primary characteristics used to define acquired apraxia of speech (AOS) have evolved to better reflect a disorder of motor planning/programming. However, there is debate regarding the feature of relatively consistent error location and type. METHOD: Ten individuals with acquired AOS and aphasia and 11 individuals with aphasia without AOS participated in this study. In the context of a 2-group experimental design, error consistency was examined via 5 repetitions of 30 multisyllabic words. The influence of error rate, severity of impairment, and stimulus presentation condition (blocked vs. random) on error consistency was also explored, as well as between-groups differences in the types of errors produced. RESULTS: Groups performed similarly on consistency of error location; however, adults with AOS demonstrated greater variability of error type in a blocked presentation condition only. Stimulus presentation condition, error rate, and severity of impairment did not influence error consistency in either group. Groups differed in the production of phonetic errors (e.g., sound distortions) but not phonemic errors. CONCLUSIONS: Overall, findings do not support relatively consistent errors as a differentiating characteristic of AOS.

SAND: a Screening for Aphasia in NeuroDegeneration. Development and normative data.

Language assessment has a critical role in the clinical diagnosis of neurodegenerative diseases, in particular, in the case of Primary Progressive Aphasia (PPA). The current diagnostic criteria (Gorno-Tempini et al., 2011) identify three main variants on the basis of clinical features and patterns of brain atrophy. Widely accepted tools to diagnose, clinically classify, and follow up the heterogeneous language profiles of PPA are still lacking. In this study, we develop a screening battery, composed of nine tests (picture naming, word and sentence comprehension, word and sentence repetition, reading, semantic association, writing and picture description), following the recommendations of current diagnostic guidelines and taking into account recent research on the topic. All tasks were developed with consideration of the psycholinguistic factors that can affect performance, with the aim of achieving sensitivity to the language deficit to which each task was relevant, and to allow identification of the selective characteristic impairments of each PPA variant. Normative data on 134 Italian subjects pooled across homogeneous subgroups for age, sex, and education are reported. Although further work is still needed, this battery represents a first step towards a concise multilingual standard language examination, a fast and simple tool to help clinicians and researchers in the diagnosis of PPA.

[Dominant Thalamus and Aphasia].

Many studies have shown that lesions of the dominant thalamus precipitate language disorders in a similar manner to transcortical aphasias, in a phenomenon known as "thalamic aphasia." In some cases, however, aphasia may not occur or may appear transiently following thalamic lesions. Furthermore, dominant thalamic lesions can produce changes in character, as observed in patients with amnesic disorder. Previous work has explored the utility of thalamic aphasia as a discriminative feature for classification of aphasia. Although the thalamus may be involved in the function of the brainstem reticular activating system and play a role in attentional network and in memory of Papez circuit or Yakovlev circuit, the mechanism by which thalamic lesion leads to the emergence of aphasic disorders is unclear. In this review, we we survey historical and recent literature on thalamic aphasia in an attempt to understand the neural processes affected by thalamic lesions.

Test de emparejamiento semántico de imágenes: instrucciones y pautas para el análisis de su ejecución / Semantic picture association test: instructions and procedures for execution assessment

Objetivo: Explorar en pacientes afásicos, previo a la exploración neurolingüística, la capacidad de extraer información semántica de las imágenes visuales.Desarrollo: El diseño y construcción de los ítems del test y de las pautas para el análisis de la ejecución, se realizó tomando como referente teórico, a la hipótesis del contenido unitario organizado, considerada como la que mejor explica las disociaciones semánticas observadas en pacientes con daño cerebral. Según esta hipótesis, el conocimiento en el sistema semántico se organiza a partir de la naturaleza biológica o no biológica de los elementos de la realidad. Plantea que tanto las propiedades de los elementos biológicos, como las de los no biológicos, están fuertemente correlacionadas, siendo compartidos muchos atributos entre miembros de las categorías supraordinadas. El test implica decidir si los conceptos a los que pertenecen dos imágenes que se presentan juntas,forman parte o no, de la misma categoría semántica. Está conformado por 42 elementos, 2 como ejemplos y 40 como ítems. En 20 ítems ambas imágenes pertenecen a la misma categoría semántica, y en los otros 20 ítems, las imágenes pertenecen a categorías semánticas diferentes. Para el análisis de la ejecución del paciente, se deben considerar dos cuestiones. Primero, los supuestos de los que parte la hipótesis del contenido unitario organizado, que ha sido tomada como referente para la construcción del test (la información en el sistema semántico se organiza a partir de su naturaleza biológica o no biológica). En segundo lugar, se debe tener en cuenta que este análisis es puramentecualitativo. Se puntúa la ejecución solo para facilitar su análisis, pero este se realiza teniendo en cuanta las categorías a las que pertenecen los ítems donde falla, sin precisar una puntuación global en el test(AU)

Objective: To evaluate in aphasic patients, the capacity to extract semantic information of visual images, before neurolinguistics assessment.Development: The development and construction of the items and procedures for assessment the execution of patients in the test, was taking the organized unitary content hypothesis as theorical referent. This hypothesis is considerate the best explanation about the semantic dissociation observed in patients with brain injury. The organized unitary content hypothesis approach, that knowledge is organized in the semantic system, by means of the biological or not biological nature of elements in the reality; and the correlation of properties of biologicaland not biological elements are strongest: the members of superior categories shared much attributes withmembers of subordinate categories. The task of the test implies to decide if the concepts of two images that are presented together, belong or not, to the same semantic category. In his structure, the task is formed by 42 elements: 2 as examples and 40 as items. In 20 items, both images belong to the same semantic category. In the others 20 items, the images belong to different semantics categories. The analysis of patient´s test execution needs the consideration of two topics. First, all supposes of the organized unitary content hypothesis that are taken as referent for the test development and construction (knowledge is organized in the semantic system by means of the biological or not biological nature of elements in the reality). Second, this analysis is purely qualitative. The punctuation of the patients execution is for facilitate the assessment. The analysis requires to considerate only the semantic categories of the images. Is not necessary a global percentile in the test(AU)

[Macdonald Critchley].

In this paper, I review some of the writings of Macdonald Critchley with an accompanying biographical sketch. The contents of his first book, "Mirror-Writing" (1928) as well as those of "Aphasiology and other aspects of language" (1970), and his views on aphasia are presented. The book "Mirror-Writing" consists of a major review of mirror writing and related reversal phenomena. This monograph provides great insight on these symptoms, which are rare today. The ideas of Critchley on cerebral function and dysfunction (evolution and dissolution) substantially succeeded those of John Hughlings Jackson. Critchley's holistic view of aphasia is also briefly reviewed in this paper. The principal of Critchley's thoughts on neurological symptomatology is an interest in the origins of the brain, behavior, and language.

FCET2EC (From controlled experimental trial to = 2 everyday communication): How effective is intensive integrative therapy for stroke-induced chronic aphasia under routine clinical conditions? A study protocol for a randomized controlled trial.

BACKGROUND: Therapy guidelines recommend speech and language therapy (SLT) as the "gold standard" for aphasia treatment. Treatment intensity (i.e., ≥5 hours of SLT per week) is a key predictor of SLT outcome. The scientific evidence to support the efficacy of SLT is unsatisfactory to date given the lack of randomized controlled trials (RCT), particularly with respect to chronic aphasia (lasting for >6 months after initial stroke). This randomized waiting list-controlled multi-centre trial examines whether intensive integrative language therapy provided in routine in- and outpatient clinical settings is effective in improving everyday communication in chronic post-stroke aphasia. METHODS/DESIGN: Participants are men and women aged 18 to 70 years, at least 6 months post an ischemic or haemorrhagic stroke resulting in persisting language impairment (i.e., chronic aphasia); 220 patients will be screened for participation, with the goal of including at least 126 patients during the 26-month recruitment period. Basic language production and comprehension abilities need to be preserved (as assessed by the Aachen Aphasia Test).Therapy consists of language-systematic and communicative-pragmatic exercises for at least 2 hours/day and at least 10 hours/week, plus at least 1 hour self-administered training per day, for at least three weeks. Contents of therapy are adapted to patients' individual impairment profiles.Prior to and immediately following the therapy/waiting period, patients' individual language abilities are assessed via primary and secondary outcome measures. The primary (blinded) outcome measure is the A-scale (informational content, or 'understandability', of the message) of the Amsterdam-Nijmegen Everyday Language Test (ANELT), a standardized measure of functional communication ability. Secondary (unblinded) outcome measures are language-systematic and communicative-pragmatic language screenings and questionnaires assessing life quality as viewed by the patient as well as a relative.The primary analysis tests for differences between the therapy group and an untreated (waiting list) control group with respect to pre- versus post 3-week-therapy (or waiting period, respectively) scores on the ANELT A-scale. Statistical between-group comparisons of primary and secondary outcome measures will be conducted in intention-to-treat analyses.Long-term stability of treatment effects will be assessed six months post intensive SLT (primary and secondary endpoints). TRIAL REGISTRATION: Registered in ClinicalTrials.gov with the Identifier NCT01540383.

Clinical properties of regional thalamic hemorrhages.

BACKGROUND: Thalamic hemorrhage constitutes 6% to 25% of intracerebral hemorrhages. Vascular lesions affecting the thalamus may cause a variety of clinical symptoms. This retrospective study aims to evaluate localization of hemorrhage and clinical symptoms in patients with thalamic hemorrhage. METHODS: One hundred and one patients with thalamic hemorrhage were examined retrospectively in our department. Hemorrhages were classified into 5 groups according to computed tomography: medial (thalamoperforate), anterolateral (tuberothalamic), posterolateral (thalamogeniculate), dorsal (posterior choroidal), and global. The relation between volume, localization, and penetration to adjacent structures/ventricles of hemorrhage and risk factors, clinical features, and prognosis were evaluated. RESULTS: The study group included 101 patients. Eighty-two percent of the patients had hypertension, 19.8% had diabetes mellitus, 14.9% had cardiac disease, and 5.9% had chronic renal failure. Mean blood pressure was 173/101 mm Hg. Decreased Glasgow coma scale was significantly higher in the global hemorrhage group than in all regional groups (Chi-square, 10.54; P = .002). Medial group hemorrhages had a significantly higher rate than anterolateral, posterolateral, and dorsal intraventricular expansion. Out of speech disorders, 49% of patients had a right thalamic lesion (especially dysarthria) and 51% of patients had a left thalamic lesion (mostly aphasia). CONCLUSIONS: In the study, we detected that the most important risk factor in thalamic hemorrhage is hypertension. The prognosis is worse in global and medial group hemorrhages, especially those which rupture to the ventricle, than the other groups. Thalamic lesions cause a variety of symptoms, including forms of aphasia, such as crossed dextral aphasia.

On the boundaries of blunt affect/alogia across severe mental illness: implications for Research Domain Criteria.

There is growing awareness that reduced expressive behaviors (e.g., blunt affect, alogia, psychomotor retardation) are characteristic of a range of psychiatric conditions, including mood and schizophrenia-spectrum disorders. From a Research Domain Criteria (RDoC) perspective, it would be critical to determine whether these symptoms manifest similarly across diagnostic groups--as they may share common pathophysiological underpinnings. The present study employed computerized acoustic analysis of speech produced in reaction to a range of visual stimuli in 48 stable outpatients with schizophrenia and mood disorders to offer preliminary understanding of this issue. Speaking assessments were administered 1 week-apart to examine how temporal stability might vary as a function of clinical diagnosis and symptom severity. Speech characteristics generally did not differ between groups and were similarly, and for the most part, highly stable over time. Aspects of speech were significantly associated with severity of psychosis and negative symptoms, but not with clinical depression/anxiety severity. Moreover, stability of speech characteristics generally did not vary as a function of diagnostic group or clinical severity. The magnitudes of group differences were almost exclusively in the negligible to small range. Speech production was associated with social functioning deficits. In sum, these preliminary data suggest that speech variables tap a stable and clinically important facet of psychopathology that cut across diagnostic categories. Computerized acoustic analysis of speech appears to be a promising method for understanding the pathological manifestation of these variables.

[Severe, reversible cerebral ischaemia following a diving accident]. / Schwere, reversible zerebrale Ischämie nach Tauchunfall.

CASE HISTORY AND CLINICAL FINDINGS: A 33-year-old experienced female diver complained of headache and chest pain when emerging after a dive. When she was rescued, tetraplegia, clouding of consciousness and aphasia were stated. The first measures consisted in the securing of the vital functions and the immediate administration of pure oxygen. Then she was transferred to the next hospital. During the 7-hour-transfer the sensory disturbances and the palsy of the left body side improved. EXAMINATIONS: Computed tomography with contrast agent revealed a subcortical parieto-occipital brain edema in the left hemisphere without midline shift. Additionally a magnetic resonance imaging (MRI) after the second pressure chamber treatment showed a smaller brain edema on the right side. DIAGNOSIS, THERAPY AND COURSE: The findings supported the diagnosis of decompression sickness type II. On the evening after the diving accident a generalised seizure occurred. Due to repeated cerebral seizures 20 mg of diazepam were administered. This was followed by a transport to the next health facility with a pressure chamber.  After two pressure chamber treatments within 24 hours the clinical symptoms disappeared, the neurological examination was unremarkable and MRI had returned to normal. CONCLUSION: An acute decompression sickness is diagnosed purely clinically. In case of even the slightest suspicion the patient should be transported to a health facility with a pressure chamber as quickly as possible because this significantly improves prognosis. Up to that point, the administration of pure oxygen is indicated. Imaging methods realised within the first hours/days are valuable for securing the diagnosis. Follow-up MRI-scans serve to reflect the course of the disease.

Aphasia centers in North America: a survey.

There is a growing trend toward dedicated programs designed to improve the lives of people with aphasia and their families. We are referring to these programs collectively as "aphasia centers." These programs purportedly differ from more traditional medically based aphasia rehabilitation. However, there is no directory of aphasia centers and no definition of what constitutes such a program. Therefore, an online survey was designed to identify and describe aphasia centers in the United States and Canada. A 37-question survey was posted online via SurveyMonkey. An introductory letter was distributed by electronic mail to a listserv and mailing lists of programs associated with aphasia. Potential respondents who considered themselves an aphasia center were asked to complete the survey. A total of 33 survey responses were analyzed, and descriptive data were compiled resulting in a description of the following aspects of aphasia centers: demographic information, mission, admission and discharge policies, assessment practices, program logistics, staffing patterns, marketing, funding, and services offered. In addition, a qualitative analysis of written text responses revealed the following key themes that appear to characterize the responding programs: services that differ from traditional aphasia rehabilitation; a sense of community; a holistic focus on quality of life, psychosocial well-being, participation, and social support; the centrality of group interaction; and variety/intensity of services.

Effects of repetitive transcranial magnetic stimulation in aphasic stroke: a randomized controlled pilot study.

BACKGROUND AND PURPOSE: Although functional imaging studies suggest that recruitment of contralesional areas hinders optimal functional reorganization in patients with aphasic stroke, only limited evidence is available on the efficacy of noninvasive brain stimulation such as repetitive transcranial magnetic stimulation aimed at suppression of contralateral overactivation. METHODS: In this randomized, controlled, blinded pilot study, the effect of 1-Hz repetitive transcranial magnetic stimulation over right-hemispheric Broca homolog in subjects with poststroke aphasia in the subacute stage was examined. According to their group allocation, patients received, in addition to conventional speech and language therapy, multiple sessions of repetitive transcranial magnetic stimulation either over the right-hemispheric inferior frontal gyrus (intervention group) or over the vertex (control group). The primary outcome parameter was the change in laterality indices as quantified by activation positron emission tomography before and after the 2-week intervention period. The clinical efficacy was evaluated with the Aachen Aphasia Test. RESULTS: At baseline, no group differences were discovered for age, laterality indices, or mean Aachen Aphasia Test scores. Four patients were lost to follow-up, but none due to side effects of the transcranial magnetic stimulation. Positron emission tomography revealed an activation shift toward the right hemisphere in the control group (P=0.0165), which was absent in the intervention group. Furthermore, the latter improved significantly clinically by a mean of 19.8 points in the Aachen Aphasia Test total score (P=0.002), whereas the control group did not. There was however no clear linear relationship between the extent of laterality shift and clinical improvement (r=0.193, P=nonsignificant). CONCLUSIONS: Repetitive transcranial magnetic stimulation might be an effective, safe, and feasible complementary therapy for poststroke aphasia.

Stuttering after right cerebellar infarction: a case study.

UNLABELLED: We report a male patient with neurogenic stuttering after cerebellar infarction. He had suffered from frontal and thalamus damage and he had exhibited aphasia, but his speech had been fluent until onset of the cerebellar infarction. Results of analysis of speech samples included the following: (1) the patient showed very frequent syllable repetition and part-word repetition. (2) The stuttering occurrence rate at the second test was much higher than at the first test. (3) Almost all stuttering occurred on initial word sounds; stuttering on the medial and final word was less frequent. (4) Adaptation effect was absent. (5) Secondary behaviors such as closing of the eyes and grimacing were observed. The internal model related to cerebellar functions can be modified using feedback-error information. Results suggest that internal model dysfunction caused this patient's stuttering. EDUCATIONAL OBJECTIVES: After reading this text, the reader will be able to: (1) provide characteristics of neurogenic stuttering after the cerebellum infarction; (2) discuss the relationship between neurogenic stuttering and functions of the cerebellum.

Auditory performance characteristics of the Computerized Revised Token Test (CRTT).

PURPOSE: To assess the Computerized Revised Token Test (CRTT) performance of individuals with normal hearing under several intensity conditions and under several spectral and temporal perturbation conditions. METHOD: Sixty normal-hearing listeners were randomly assigned to 1 of 3 groups. Group 1 provided performance-intensity information about CRTT performance using uncompressed acoustic stimuli. Groups 2 and 3 completed the CRTT using temporally and spectrally compressed and expanded stimuli. CRTT performance functions were plotted for each group. RESULTS: Group 1 required minimal audibility to perform maximally on this task. As expected, Groups 2 and 3 showed significant differences across subtests, regardless of distortion condition. Mean differences in performance between successive conditions for Group 2 increased beyond 40% time compressed. There was 1 significant difference for the time-expanded condition. There were no differences across frequency compressed and expanded conditions. CONCLUSION: Young listeners require limited signal gain on the CRTT to achieve maximum performance. Time and frequency compression and expansion results were consistent with previous findings with varying types of speech stimuli. The results have implications for administration and interpretation of the CRTT administered to persons from other populations and will help in the development of a normative database for the CRTT.

Palinacousis - auditory perseveration: two cases and a review of the literature.

Palinacousis is an auditory illusion rarely reported in cases of temporal lobe dysfunction. Detailed observations where made by Jacobs et al. in 1973. Since that time, only a few other cases have been described in the literature. After reviewing the literature and comparing our clinical experience, we believe that palinacousis can occur as an aura, a simple partial seizure, a complex partial seizure, and/or a postictal event. Within one academic year, we observed two patients who experienced palinacousis. Palinacousis maybe more common than recognized in patients with receptive aphasias or diffuse cerebral dysfunction, whose language deficits preclude adequate description. It is important to differentiate palinacousis from auditory hallucinations seen in psychotic and psychiatric patients. Identification of palinacousis as an aura, simple partial seizure, complex partial seizure, and/or postictal phenomenon can help localize potential lesions and improve patient care.

[The peculiarities of speech disturbance in patients with arteriovenous malformations of the caudate nucleus and the thalamus].

Clinical and neuropsychological study of 28 patients with arteriovenous malformations (AVM) of the caudate nucleus and 36 patients with AVM of the thalamus has been conducted. After surgical removal of the caudate nucleus, speech disturbances developed in 4 out of 8 patients with left-side AVM and in 1 patient, a converted left-hander, with right-side AVM. All 5 patients had mild speech disturbances, which differed by character in dependence of the AVM location. In case of AVM location in the head of the caudate nucleus, the speech disturbances were represented by perseverations and were similar to those caused by the lesion in the Broca area. In case of the caudate nucleus lesion, naming was mildly affected that resembled temporal aphasia. After surgical removal of AVM in the left thalamus in 9 patients, complex and rather stable speech disturbances developed in 7 cases. They were featured by the signs of frontal and temporal aphasias, i.e. there were perseverations and disturbances of naming, auditory and speech memory. The peculiarities of speech disturbances in lesions of the caudate nucleus and the thalamus were well explained by their anatomic and functional correlations with different regions of brain speech cortex. Speech disturbances in various subcortical lesions are reviewed. In the authors' opinion, subcortical aphasias do not have any particular character but include the same factors in different combinations as cortical ones that is determined by the presence of common functional systems for speech support which comprise cortical and subcortical patterns.

Asymmetry of long-latency auditory evoked potentials in LGI1-related autosomal dominant lateral temporal lobe epilepsy.

PURPOSE: To investigate auditory processing with cortical long-latency auditory evoked potentials (AEPs) in patients with autosomal dominant lateral temporal lobe epilepsy (ADTLE). METHODS: Eight patients with LGI1-related ADTLE belonging to a family with predominantly aphasic seizures were studied. Sixty-five individuals without epilepsy served as controls. AEPs (N1-P2 amplitudes) to binaural tones were recorded over the left and the right hemispheres. Brainstem auditory evoked potentials (BAEPs) to monaural rarefaction clicks also were analyzed. Group differences were statistically assessed with Student's t test and repeated-measures analysis of variance. RESULTS: Left N1-P2 AEP amplitudes were moderately reduced in ADTLE patients (p = 0.005). No group differences in BAEP were found, indicating unaffected cochlear system and auditory brainstem pathways. CONCLUSIONS: A moderate, but highly significant reduction in N1-P2 AEP amplitudes over the left hemisphere was demonstrated in patients with ADTLE. This finding corresponds to the cardinal symptom of aphasia in this family, and also to the generally prevailing left-sided EEG abnormalities in this condition. The background for this electrophysiologic lateralization in LGI1-related epilepsy is unknown. It may be related to a specific function of LGI1 in the dominant hemisphere.