Normal Language Function Research Articles

Evaluation of Sleep EEG Changes in Paediatric Patients with Language Dysfunction: A Follow Up Study

Abstract Background Several case reports and studies have described an association between sleep epileptiform discharges and language dysfunctions. This has been partly confirmed in studies that have investigated the effect of this epileptiform discharges on neurocognitive function. Objectives To screen for sleep-potentiated epileptiform discharges in children with language dysfunction (language delay or regression) and to evaluate the effect of treatment of these epileptiform discharges on language dysfunction. Methods The study was conducted on 93 children with language delay or language regression. Patients were recruited from the pediatric neurology clinic, pediatric outpatient clinic, phoniatrics outpatient clinic and the inpatient neurology ward at the Ain Shams University Children’s hospital, Cairo, Egypt in the period between February 2020 and November 2021. A 90- minute sleep electroencephalography, intelligence quotient level and language age were done for all patients included in the study. Children who had an active electroencephalography with uncontrolled clinical seizures or persistently epileptogenic activity without clinical seizures received treatment according to type of activity then after 6 months they were subjected to follow up electroencephalographyand assessment of intelligence quotient level and language age. Results The enrolled patients were divided into two groups: Group (1) including 28 (30%) patients with either or both of epileptogenic activity and clinical seizures and group (2) including 65 (70%) patients without either epileptogenic activity or clinicalseizures. We found 24 (85.7 %) children in group 1 had clinical seizures with median age of onset 2.5 years (range from 1-8 years). Further in the first group, 21 (85.7 %) of children showed presence ofepileptogenic activity with 10 (47.6 %) of children showed spike and slow wave, 6 (28.6 %) showed sharp wave, 3 (14.3 %) showed continuous spike and wave during slow wave sleep (CSWS), 2 (9.5 %) children showed sharp and slow wave. In our study, levetiracetam was given as first line treatment in patients with active seizures. An add-on therapy was given in patients who were not controlled on one antiepileptic drug. A follow up 90 minutes sleep electroencephalography was done and showed a highly significant reduction in epileptogenic activity with a p value of < 0.001. A follow up language test and intelligence quotient level score were done and showed a highly significant improvement with p value of (0.001 and 0.009) respectively. Conclusion Epileptiform activities with or without epilepsy in children may alter normal language function. Treatment of these epileptogenic activity affect improvement of this language dysfunction. Trial registration: ClinicalTrials.gov I.D: NCT05487521.

Akinetic Mutism and Cognitive‐Affective Syndrome caused by unilateral PICA infarction

AbstractBackgroundAkinetic mutism (AM) is characterized by sparse volitional motor and speech activation with reasonably preserved arousal and vigilance functions. Akinetic mutism, the most severe of these disorders, is most commonly associated with bilateral hemispheric pathology, although unilateral lesions may produce this condition as well.MethodCase: Our patient is a 42‐year‐old right handed man who presented to the emergency department with an acute onset of akinetic mutism. His family described him as a calm and intelligent individual with a good cultural knowledge level and without any evident cognitive abnormality before he suddenly experienced akinetic mutism. On examination, he was alert but produced no spontaneous speech and had only rare, spontaneous movement of his arm and leg. With repeated prompting, he followed single‐step commands.ResultMagnetic resonance imaging demonstrated an infarction in the distribution of the left posterior inferior cerebellar artery. During the course of 7 days, as the patient became more interactive, he demonstrated normal language function. As he became more communicative, cognitive impairment became apparent. Neuropsychological evaluation were performed after approximately 12 days after onset because of the impossibility of test administration during the acute phase. Impaired performances were evident on executive function testing with difficulties in planning, abstract reasoning, set‐shifting and perseveration. Furthermore, attention disorders and memory dysfunction were mild observed and were probably due to the poor ability of planning and organization. Language tests revealed mild deficits in the semantic sphere with paraphasia, anomia and circumlocutory expressions. During psychometric testing, the patient presented agitated and anxious behavior with affective air hunger and episodes of crying. Brain SPECT were performed after approximately 14 days after onset. Brain SPECT demonstrated hyporperfusion in Lt. cerebellar and frontal cortex.ConclusionThe syndrome of akinetic mutism is typically the result of bilateral hemispheric injury, usually involving the anterior cingulate gyri. Other locations for lesions producing akinetic mutism include the thalami, globus pallidus, internal capsule, and frontal white matter. We describe a man with akinetic mutism and cognitive impairment due to an ischemic stroke in the distribution of the left PICA.

Cognitive development after perinatal unilateral infarctions: No evidence for preferential sparing of verbal functions.

Even children with extensive perinatal left-sided lesions have been reported to show normal language functions based on right-hemispheric language reorganization. This reorganization can lead to deficits in originary right hemispheric functions ("crowding hypothesis"). In a previous study, however, we identified epilepsy (even when well-controlled), and not language reorganization, as the major risk factor for impaired nonverbal functions. Here, we asked whether verbal and nonverbal functions develop differently, and whether they share the same risk factors. We investigated 23 patients (11f, Md=12.56 years) with perinatal strokes (16 left-sided, 8 with epilepsy), and 23 healthy age-matched controls (8 f, Md=12.42years). Language functions were assessed using the Potsdam Illinois Test of Psycholinguistic Abilities, nonverbal intelligence with the Test of Nonverbal Intelligence, language lateralization with functional MRI, and lesion size with MRI-based volumetry. We found no systematic difference between verbal and nonverbal skills in our patients or controls [median difference Z(PITPA)-Z(TONI): patients=-0.03, controls=-0.06]. Accordingly, verbal and nonverbal functions were strongly correlated in patients (r=0.80) and in controls (r=0.74). Language ability correlated significantly with epilepsy. Furthermore, in patients with epilepsies, verbal skills were significantly lower than in controls. In our cohort, we found no evidence for a differential effect of perinatal strokes on the development of verbal versus nonverbal functions, and, specifically, no evidence for a preferential sparing of verbal functions. Epilepsy, even when well-controlled, was confirmed as a single key risk factor for verbal functions.

Association of epileptiform brain activity and specific language impairment (SLI) in preschool children

BackgroundEpileptiform activities can cause transient or permanent deficits that affect the children during development and may be accompanied by neurodevelopmental disorders like specific language impairment.ObjectivesThe objective of this study was to find if there is a possible association and the impact of epilepsy and epileptiform activity in children with specific language impairment.Patients and methodsThe study was conducted on 80 children suffering from specific language impairment and 80 age and sex match healthy control children. Computed tomography brain was performed and electroencephalography was recorded for children. Intelligence quotient level, cognitive age, social, and phoniatric assessment were done for all patients.ResultsEighty children with specific language impairment (51 males and 29 females) with a mean age of 4.11 ± 1.93. Patients with specific language impairment showed significantly higher rates of abnormal electroencephalography (P = 0.006) and epilepsy (P < 0.001) compared to the control group. Spearman correlation demonstrated a highly negative significant relationship linking the language, intelligence quotient with abnormal electroencephalography and epilepsy (r = − 0.91, P < 0.01 and r = − 0.91, P < 0.01 respectively). Also, there was a moderately inverse significant relationship linking the cognitive age, social with abnormal electroencephalography, and epilepsy (r = − 0.70, P < 0.05 and r = − 0.65, P < 0.05 respectively).ConclusionEpileptiform activities even without epilepsy in preschool children may alter normal language function. Specific language impairment was associated with lower intelligence quotient levels, social, and cognitive age.Trial registrationClinicalTrials.gov ID: NCT04141332

Auditory Verbal Hallucinations in Psychosis: Abnormal Perceptions or Symptoms of Disordered Thought?

Auditory verbal hallucinations (AVHs) are considered as hallmark symptoms of psychosis, more specifically of schizophrenia. A substantial body of evidence indicates that AVHs can be attributed to a disorganization of overall speech capacity in psychotic subjects. AVHs are associated with activation of cortical areas of the brain that are related to speech production and perception; "voices" in deaf patients seem to be about the message rather than the sound of it; the content of AVHs is often related to that of delusional ideas; the internal or external location of AVHs makes little diagnostic difference; AVHs are often related to the patient's subvocal speech, having identical content with that, and they have been theorized as a misattribution of inner speech (i.e., the patient's own thoughts) to external sources. The aforementioned evidence comes close to certain long-standing insights mainly of the French psychiatric (de Clérambault) and psychoanalytical (Lacan) school, according to which, 1) the outside world is perceived through normal language function, 2) a language disorder is central to schizophrenic phenomena, and 3) AVHs represent a fragmentation and autonomization of speech (thought) function in schizophrenic patients (de Clérambault: "hallucinations think"). Today, several authors agree that 1) operationalized definitions have led to an oversimplification of psychopathology, and 2) a more theoretically informed understanding and an integration of different levels of explanation of psychotic phenomena is needed. Thus, psychotic AVHs should be investigated beyond their narrow classification as disordered perceptions, in the wider context of formal thought disorder and disordered language capacity.

Clinical practice of repair of large tracheal defects with local tension free flaps

Objective: To investigate a simple and practical method for the repair of large tracheal defects. Methods: From April 2015 to October 2017, 10 patients with large tracheal wall defects after thyroid carcinoma underwent two phase repair with cervical tension free flap with modified design. In the longitudinal direction of the leakage, design two pieces of random flap outside the top angle of 45°, respectively, and the side turn double flip flap to repair the leak, outward and upward forming tension, avoid collapse after healing. Results: Large tracheal wall defects in 10 cases were successfully repaired, and normal respiration and language functions were recovered quickly.With following-up of 6-30 months(the medran was 12 months), the airway kept normal ventilation, no recurrence, and 1 patient with pulmonary metastasis had a stable condition. Conclusion: The modified tension free flap can be used for the repair of large defects of trachea with a good efficacy.

Comments on Devinsky O, Lai G. Spirituality and religion in epilepsy. Epilepsy & Behavior 2008;12:636–643

The more subjective the phenomenon, the less easily can science focus on its image. Spiritual and religious experiences are deeply personal and verbally inexpressible. The scientific effort to dissect and define them may miss or destroy their essence. Yet, spiritual and religious thoughts are phenomena of the mind and brain with physiologic and structural correlates. The presence of spiritual beliefs among all cultures strongly suggests that the human brain is programmed to experience and explain parts of existence in spiritual terms. Like language, spirituality develops in different forms in different cultures, yet the emotional–cognitive processes and underlying anatomy probably share many elements. The aphasias helped usher in modern neurology 150 years ago. Linguists and cognitive neuroscientists actively study normal language function. In contrast, priests and, occasionally, psychiatrists focus on spiritual–religious disorders, but “normal” spirituality and religious experiences rarely reach the fringes of science. (p. 637).

Network hyperexcitability in a patient with partial reading epilepsy: Converging evidence from magnetoencephalography, diffusion tractography, and functional magnetic resonance imaging

ObjectiveThe pathophysiological mechanisms of partial reading epilepsy are still unclear. We delineated the spatial–temporal characteristics of reading-induced epileptic spikes and hemodynamic activation in a patient with partial reading epilepsy. MethodsMagnetoencephalography (MEG) was recorded during silent letter-by-letter reading, and the source of reading-induced spikes was estimated using equivalent current dipole (ECD) analysis. Diffusion tractography was employed to determine if the white matter pathway connected spike initiation and termination sites. Functional magnetic resonance imaging (fMRI) was employed to determine the spatial pattern of hemodynamic activation elicited by reading. ResultsIn 91 spike events, ECDs were clustered in the left posterior basal temporal area (pBTA) during Katakana reading. In 8 of these 91 events, when the patient continued to read >30min, another ECD cluster appeared in the left ventral precentral gyrus/frontal operculum with a time-difference of ∼24ms. Probabilistic diffusion tractography revealed that the long segment of the arcuate fasciculus connected these two regions. fMRI conjunction analysis indicated that both Katakana and Kanji reading activated the left pBTA, but Katakana activated the left lateral frontal areas more extensively than Kanji. ConclusionsProlonged reading of Katakana induced hyper-activation of the cortical network involved in normal language function, concurrently serving as the seizure onset and symptomatogenic zones. SignificanceReflex epilepsy is believed to result from intrinsic hyper-excitability in the cortical regions recruited during behavioral states that trigger seizures. Our case shows that reading epilepsy can arise from a hyperexcitable network of cortical regions. Physiological activation of this network can have cumulative effects, resulting in greater reciprocal network propagation and electroclinical seizures. These effects, in turn, may give insights into the brain networks recruited by reading.

Connectivity between Right Inferior Frontal Gyrus and Supplementary Motor Area Predicts After-Effects of Right Frontal Cathodal tDCS on Picture Naming Speed

BackgroundCathodal transcranial direct current stimulation (tDCS) of the right frontal cortex improves language abilities in post-stroke aphasic patients. Yet little is known about the effects of right frontal cathodal tDCS on normal language function. Objective/hypothesisTo explore the cathodal tDCS effects of the right-hemispheric homologue of Broca's area on picture naming in healthy individuals. We hypothesized that cathodal tDCS improves picture naming and that this effect is determined by the anatomical and functional connectivity of the targeted region. MethodsCathodal and sham tDCS were applied to the right inferior frontal gyrus in 24 healthy subjects before a picture-naming task. All participants were studied with magnetic resonance imaging at pre-interventional baseline. Probabilistic tractography and dynamic causal modeling of functional brain activity during a word repetition task were applied to characterize anatomical and functional connectivity. ResultsSubjects named pictures faster after cathodal relative to sham tDCS. The accelerating effect of tDCS was explained by a reduced frequency of very slow responses. tDCS-induced acceleration of picture naming correlated with larger volumes of the tract connecting the right Broca's area and the supplementary motor area (SMA) and greater functional coupling from the right SMA to the right Broca's area. ConclusionsThe results support the notion that the after-effects of tDCS on brain function are at least in part determined by the anatomical and functional connectivity of the targeted region.

Using Photos and Visual-Processing Assistive Technologies to Develop Self-Expression and Interpersonal Communication of Adolescents with Asperger Syndrome (AS)

Introduction The purpose of this paper is to examine the use of photographs and assistive technologies for visual information processing as motivating tools for interpersonal and intrapersonal communication of adolescents with Asperger Syndrome (AS). In May 2013 the American Psychiatric Association (APA) removed from the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) the diagnostic criteria for Autistic Disorder (AD), Asperger Syndrome (AS), and Pervasive Developmental Disorder--not otherwise specified (PDD-NOS). DSM-5 presented a new category called Autism Spectrum Disorder (ASD), which incorporates these previously separate diagnoses (American Psychiatric Association, 2013). While there are some who would argue that the Aspergers-like label which doctors may continue to use when diagnosing ASD should dispel these fears, others still see it as the removal of a condition, which for several decades has had its own unique characteristics, and therefore a negative development which will reduce research funding and affect public perception (Aspergers Advice, 2013). In our research we include AS as part of the ASD spectrum. The choice to adhere to AS definitions stems from two key reasons: firstly, our research was designed before the publication of DSM-5; secondly, study participants were diagnosed according to the previous professional definitions. Accordingly, the investigative approach was also based on the traditional AS definition, as this was still the current terminology when the study was conducted. AS is characterized by high cognitive abilities, normal to high intelligence, and normal language function (Bauer, 1996; Graetz & Spampinato, 2008). However, like almost all people on the ASD spectrum, they also typically lack social skills and have more difficulty with identifying emotions through facial expression than their peers without autism (LaCava, Golan, Baron-Cohen, & Smith--Myles, 2007; Lindner & Rosen, 2006. Their poor social skills limit their ability to conduct reciprocal discourse and most prominently present a dogged focus on a small list of conversation topics (Attwood, 2006). These characteristics cause them to be truly authentic when engaging with others as people with AS have no natural instinct for manipulation and habitually say what they believe to be true, a trait that may also cause embarrassment and inadvertent offense (Att-wood, 2006). The varied characteristics of students with AS require differentiated instruction, including interventions that foster interests and strengths while providing strategies to compensate for areas of weakness. School curriculums often focus on the development of communication skills and expression in academic texts centered on selected subject matter, but for AS students special attention must be directed to providing tools to cope with understanding social and personal communication, such as dealing with changes, codes, and hints. Without guidance, these struggles may cause frustration, and manifest in behaviors considered by society to be unsuitable. Because many students with AS are described as visual learners (Ganz, Earles-Vollrath, & Cook, 2011; Rao & Gagie, 2006) they tend to show improved response to information presented visually. By using a student's visual processing strength, these strategies can help decrease reliance on areas of deficits, such as auditory processing and communication. The use of various visual aids is necessary for teaching and developing communication and expression along with class conversation (Hume, Loftin, & Lantz, 2009; Meadan, Ostrosky, Triplett, Michna & Fettig, 2011; Rao & Gagie, 2006). Photos provide a glimpse into the private world of students, and group viewing can open the door to the child's experiences, hobbies, favorite places, etc. They can also serve as a starting point for interaction with peers (Shalita, Friedman, & Harten, 2011). …

Differential brain glucose metabolic patterns in antipsychotic-naive first-episode schizophrenia with and without auditory verbal hallucinations

Auditory verbal hallucinations (AVHs) are a core symptom of schizophrenia. Previous reports on neural activity patterns associated with AVHs are inconsistent, arguably owing to the lack of an adequate control group (i.e., patients with similar characteristics but without AVHs) and neglect of the potential confounding effects of medication. The current study was conducted in a homogeneous group of patients with schizophrenia to assess whether the presence or absence of AVHs was associated with differential regional cerebral glucose metabolic patterns. We investigated differences between patients with commenting AVHs and patients without AVHs among a group of dextral antipsychotic-naive inpatients with acute first-episode schizophrenia examined with [(18)F]fluoro-deoxyglucose positron emission tomography (FDG-PET) at rest. Univariate and multivariate approaches were used to establish between-group differences. We included 9 patients with AVHs and 7 patients without AVHs in this study. Patients experiencing AVHs during FDG uptake had significantly higher metabolic rates in the left superior and middle temporal cortices, bilateral superior medial frontal cortex and left caudate nucleus (cluster level p < 0.005, family wise error-corrected, and bootstrap ratio > 3.3, respectively). Additionally, the multivariate method identified hippocampal-parahippocampal, cerebellar and parietal relative hypoactivity during AVHs in both hemispheres (bootstrap ratio < -3.3). The FDG-PET imaging technique does not provide information regarding the temporal course of neural activity. The limited sample size may have increased the risk of false-negative findings. Our results indicate that AVHs in patients with schizophrenia may be mediated by an alteration of neural pathways responsible for normal language function. Our findings also point to the potential role of the dominant caudate nucleus and the parahippocampal gyri in the pathophysiology of AVHs. We discuss the relevance of phenomenology-based grouping in the study of AVHs.

Heralding Cerebellar Mutism: Evidence for Pre-surgical Language Impairment as Primary Risk Factor in Posterior Fossa Surgery

The aim of this study is to identify possible risks factors for the occurrence of cerebellar mutism syndrome (CMS) in children with posterior cranial fossa tumours. Children diagnosed with posterior fossa tumours consecutively admitted to our institution between 2006 and 2008 were the subjects of this prospective study. Besides standard neurological and radiological evaluations, all children underwent thorough neuropsychological assessments at admission and following surgery. Children under two or older than 16years of age and those with a severe pre-operative clinical condition precluding neuropsychological assessment were excluded. Thirty-four children met the inclusion criteria. They were divided into two groups. Group I consisted of 23 children with normal language on admission and group II had 11 children showing pre-operative language impairment (PLI). PLI was observed in 11 children (32.4%: group II). Post-operatively, seven out of 34 children developed CMS (20.6%), all of them belonging to group II. In group II, indeed, the incidence of CMS was 63%. No case of CMS was observed in group I. PLI regressed after the operation in three out of the four subjects belonging to group II who did not develop CMS. PLI remained unchanged in the last child of this group. Posterior fossa tumour resection can have different effects on children with pre-existing language impairment (PLI). PLI can be considered a subclinical state of CMS in some children with posterior fossa tumour. However, in some children with PLI, the tumour resection may improve the linguistic abilities, as well as the other neurocognitive performances. In the present series, children with normal pre-operative language function did not develop post-operative mutism.

Agnosias.

The neuropsychological disorder, known as visual agnosia, refers to the impairment in deriving the meaning of a visually presented stimulus, in spite of the affected individual having intact sensory and low-level vision, and normal language and semantic function. This type of disorder is intriguing both clinically and scientifically, and vision scientists have studied visual agnosia as a means of shedding light on how the normal visual system functions. Considerable progress has been made in this domain, in parallel with detailed behavioral and neural investigations of the visual system of neurologically intact individuals and of nonhuman primates. Here, we focus specifically on the neuropsychological studies and provide a broad overview of the wide range of impairments that fall under the label 'visual agnosia', including those acquired following brain damage in premorbidly normal individuals, those that appear to have been present since birth, and those whose onset is late in life and is associated with neurodegeneration. We also outline the different subtypes of visual agnosia, including those that affect primarily the recognition of faces, words, or objects, and we lay out some of the key questions currently being addressed by researchers in this domain. Copyright © 2010 John Wiley & Sons, Ltd. For further resources related to this article, please visit the WIREs website.

Surgical strategies for glioma involving language areas

Successful treatment of gliomas in or adjacent to language areas constitutes a major challenge to neurosurgery. The present study was performed to evaluate the procedure of language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia when performed prior to resective glioma surgery. Thirty patients with gliomas and left-hemisphere dominance and, who underwent language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia before resective glioma surgery, were analyzed retrospectively. All patients had tumors in or adjacent to cortical language areas. The brain lesions were removed according to anatomic-functional boundaries with preservation of areas of language function. Both preoperative and postoperative functional findings were evaluated. Intraoperative language areas were detected in 20 patients but not in four patients. Language mapping failure for reasons attributable to the anaesthesia or to an intraoperative increase in intracranial pressure occurred in six cases. Seven patients presented with moderate or severe language deficits after six months of follow-up. Total resection was achieved in 14 cases, near-total resection in 12 cases and subtotal resection in four cases. Intraoperative cortical electrical stimulation is an accurate and safe approach to identification of the language cortex. Awake craniotomy intraoperative cortical electrical stimulation, in combination with presurgical neurological functional imaging to identify the anatomic-functional boundaries of tumor resection, permits extensive tumor excision while preserving normal language function and minimizing the risk of postoperative language deficits.

What's ‘Right’ in Language Comprehension: Event‐Related Potentials Reveal Right Hemisphere Language Capabilities

AbstractAlthough the term ‘nonverbal’ is often applied to the right cerebral hemisphere (RH), a growing body of work indicates that the RH can comprehend language and, indeed, that it makes critical contributions to normal language functions. Reviewed here are studies that have examined RH language capabilities by combining visual half‐field presentation methods with event‐related potential (ERP) measures. Because they afford temporal and functional specificity and can be obtained as participants simply process language for meaning, ERPs provide especially valuable insights into RH language functions. Such studies suggest that the RH appreciates word‐ and message‐level meaning information, and that it may play a particularly important role in the processing of relatively unpredictable semantic relationships. In addition, this work suggests that patterns observed for everyday language processing may often be an emergent property of multiple, distinct mechanisms operating in parallel as the left and right hemispheres jointly comprehend language.

A Case of Progressive Apraxia of Speech in Pathologically Verified Alzheimer Disease

To present the case of a man with progressive speech loss and other clinical features and diagnostic tests consistent with fronto-temporal dementia but whose postmortem neuropathologic findings revealed Alzheimer disease (AD). Progressive apraxia of speech presents without true language abnormalities, usually seen with frontal lesions and not associated with AD pathology. We describe the clinico-pathologic case of an 87-year-old man with progressive loss of speech function and present the prospective presentation of his syndrome using structural (magnetic resonance imaging) and metabolic (positron emission tomography) neuro-imaging studies, neuropsychologic testing, and pathology. His syndrome was characterized over the first 6 to 9 years by progressive deterioration of speech production, alteration of mood, and dysphagia but near normal language, memory, and visual-spatial function. At 8 years, fluorodeoxyglucose-positron emission tomography showed largely frontal metabolic abnormality. Over his final 1(1/2) years, he was mute and withdrawn. Neuropathologic findings showed neuritic plaques and neurofibrillary tangles, but no signs of frontotemporal dementias such as Pick bodies or ubiquitinated tau-negative inclusions. There can be overlap in the presentation of fronto-temporal dementia and AD despite the disparate pathologic bases of the underlying diseases. It has yet to be determined how to differentiate these diseases in such variant presentations and whether such atypical AD syndromes are equally amenable to standard therapies for AD.

Acquisition of the Second Language By Patients with Brain Injury After Prolonged Coma

Acquisition of the Second Language By Patients with Brain Injury After Prolonged Coma Eight patients with cranio-cerebral trauma after prolonged coma participated in a study investigating their ability to learn a second language (L2). A severe traumatic brain injury (TBI) results in a dramatic decrease of consciousness and cerebral activity. If the state lasts more than 48 hours, it is considered a coma. Due to irreversible changes in the brain, chances of regaining premorbid physical and mental functions drastically diminish after 4 weeks of coma. Only a limited number of post-coma patients succeed in regaining full efficiency. The present study verifies whether it is possible for these patients, for whom it takes months, sometimes even years, of regular exercise to regain normal language functions in the native language, to learn an L2. The experiment was carried out within "The Academy of Life", a program of classes for in- and outpatients, whose aim is to re-adjust patients to everyday life in society after discharge from hospital. All the subjects had known English to some extent before their accidents. There were 18 sessions lasting 1.5-2 hours within a period of 6 months. The subjects were examined twice: before and after the program. The results show that learning an L2 is still possible. The subjects improved their performance in the following language components: lexicon, grammar and pronunciation. The acquisition process was delayed by post-traumatic aphasia which led to a lack of criticism of the patients' own utterances, as well as a dysfunction of the switch mechanism. The subjects also suffered from disorganization of memory and concentration. However, some patients achieved higher results than it had been expected. The relatively young age of the subjects (mean 20.6 years) increased their chances of learning an L2.

FMRI reveals novel functional neuroanatomy in a child with perinatal stroke

Children who have experienced a perinatal stroke often develop normal language function, but the neurobiologic mechanisms underlying this plasticity remain unclear. In this study, we used fMRI to compare, at two ages, the functional neuroanatomy of a child with perinatal stroke with that of age-appropriate cohorts of typically developing children. Although the data for this child are similar to the control group, there are age-dependent differences.

Akinetic Mutism Following Unilateral Anterior Cerebral Artery Occlusion

Akinetic Mutism Following Unilateral Anterior Cerebral Artery Occlusion

Brain Reorganisation in Cerebral Palsy: A High-Field Functional MRI Study

Early brain damage may induce alternative organisation of cortical brain functions. This may happen even if there is no damage to the cortex. We assessed a 15-year-old girl with a perinatal left-sided subcortical lesion without cortical damage by functional MRI at 3 Tesla. The patient had congenital hemiparesis, mirrored limb movements and normal language function. Functional MRI was used to assess language using orthographic-lexical retrieval and noun-verb generation tasks, and demonstrated right-sided language dominance. Functional MRI of motor function was assessed for both hands separately, by squeezing a rubber balloon. Both hand movements induced asymmetric bilateral activation of the motor cortex, with a predominance of contralateral activation. Language-associated activity is usually left-hemispheric, but was found in the undamaged right-sided hemisphere. Motor function was associated with the unusual pattern of bilateral cortical activation. The MR findings explain the clinical features and suggest widespread alternative cortical organisation in the presence of a focal lesion confined to subcortical structures.