Speech Disturbance Research Articles

Artificial Neural Networks Combined with the Principal Component Analysis for Non-Fluent Speech Recognition.

The presented paper introduces principal component analysis application for dimensionality reduction of variables describing speech signal and applicability of obtained results for the disturbed and fluent speech recognition process. A set of fluent speech signals and three speech disturbances—blocks before words starting with plosives, syllable repetitions, and sound-initial prolongations—was transformed using principal component analysis. The result was a model containing four principal components describing analysed utterances. Distances between standardised original variables and elements of the observation matrix in a new system of coordinates were calculated and then applied in the recognition process. As a classifying algorithm, the multilayer perceptron network was used. Achieved results were compared with outcomes from previous experiments where speech samples were parameterised with the Kohonen network application. The classifying network achieved overall accuracy at 76% (from 50% to 91%, depending on the dysfluency type).

Carotid web: an important cause of stroke in young people

A 40-year-old female presented 3 hours and 15 minutes after acute onset speech disturbance, left-sided weakness, headache and neck discomfort. She was a smoker and had a history of fibromyalgia and anxiety disorder. Her regular medications included a selective serotonin reuptake inhibitor and propranolol. Physical examination showed mild dysphasia and dysarthria, left hemiparesis (face, arm and leg) and sensory deficit with tactile neglect (National Institutes of Health Stroke Scale score of 7).

PHONETIC AND PSYCHOLINGUISTIC APPROACH TO CONSIDERATION OF SPEECH PATHOLOGY "STUTTER"

Problem statement. The article examines the phenomenon of stuttering from a phonetic and psycholinguistic point of view. Speech rhythm has recently become a close object of research in phonetics and speech. The actual data from these studies have not penetrated significantly into the field of speech therapy. The speech rhythm is considered from the point of view of physiology, neurolinguistics, psycholinguistics. Data on the primary assimilation of the parameters of the speech rhythm of the native language from the point of view of phonetics create the idea of "inscribing" articulatory movements into the rhythmic matrix of words and phrases. Violations in the implementation of this matrix make it possible to trace the behavior of articulatory complexes when the rhythmic basis fails. The paper describes an experimental study of speech rhythm disturbance as the cause of speech errors (pathologies). Results and conclusion. Verbal and non-verbal components are used to rhythmize speech activity. Corrective techniques are used, because of which a prolonged emotionally positive state arises, and the voluntary use of a new speech program begins. This state is introduced in the process of auto-training. Emotionally comfortable state when using rhythmized speech is fixed on functional speech training. We are talking about strengthening the speech rhythm of the native language without distorting its parameters.

Primary progressive aphasias: clinical and genetic heterogeneity and diagnostic difficulties

This systematic review describes primary progressive aphasia (PPA) variants and includes the authors' own clinical observations. Over 20 genes have now been identified, with mutations that are directly involved in the development of the behavioural variant of frontotemporal dementia, as well as other forms of PPA. Pathomorphological markers of Alzheimer's disease were identified in 76% of cases of logopenic PPA, while signs of frontotemporal dementia associated with TDP-43 were identified in 80% of cases of the semantic variant, and those associated with TDP-43/tau were identified in 64% of cases of agrammatic PPA. The clinical diagnosis of PPA is based on a history of long-term, progressive speech disturbances and identifying a particular variant: agrammatic, semantic or logopenic. The primary variant of the speech disorder cannot be identified in approximately 30% of cases. The focus should be on the main and additional clinical signs (presence of agrammatism, object naming, word comprehension, preserved repetition), as well as neuroimaging (presence of asymmetrical frontal and/or temporal lobe atrophy).
 The article also provides key aspects of differential diagnosis of the PPA variants, and puts forth a stepwise diagnostic algorithm. It examines features of PPA progression, with possible development of corticobasal syndrome, illustrated by a clinical case. A dissociation between neuroimaging findings and clinical disease variant is also demonstrated to be possible. Different neuropsychological assessments of patients with aphasia and methods of determining the severity of speech dysfunction are presented. Standardized aphasia assessment tools and the adapted PPA severity scale are provided.

Correction of speech disturbances in elevated form of dysartria in elder preschool children

This article discusses the use of speech therapy rhythmics in order to correct speech disorders in preschoolers with an erased form of dysarthria. In the course of this work were in s manifest features of tempo-rhythmic organization of speech of children with the erased form of dysarthria; the positive influence of speech therapy rhythmics on children of this category is described and examples of effective exercises in the process of its use are given.

A homozygous ABHD16A variant causes a complex hereditary spastic paraplegia with developmental delay, absent speech, and characteristic face

Hereditary spastic paraplegia (HSP) is a genetically and clinically heterogeneous genetic disease characterized by progressive weakness and spasticity predominantly affecting the lower limbs. Complex HSP is a subset of HSP presenting with additional neuronal and/or non-neuronal phenotypes. Here, we identify a homozygous ABHD16A nonsense variant in two affected children in a Chilean family. Very recently, two groups reported patients with biallelic ABHD16A whose clinical presentation was similar to that of our patients. By reviewing the clinical features of these reports and our patients, ABHD16A-related HSP can be characterized by early childhood onset, developmental delay, intellectual disability, speech disturbance, extrapyramidal signs, psychiatric features, no sphincter control, skeletal involvement, thin corpus callosum, and high-intensity signals in white matter on T2-weighted brain MRI. In addition, our affected siblings showed a characteristic face, sleep disturbance, and nodular and hyperpigmented skin lesions, which have not previously been reported in this condition.

BRMP-01. Awake cranial surgery with intraoperative language mapping for brain tumors. A single-center experience

Abstract BACKGROUND Maximal safe resection of brain tumors affecting language areas has been a matter of increasing interest worldwide in the last decades. Functional MRI, tractography, and awake cranial surgery are standard procedures in our department since 2006. The aim of this study was to describe our experience in a series of 58 patients who underwent awake cranial surgery with intraoperative language mapping. METHODS Retrospective study of 58 adult patients who underwent awake surgery for brain tumors between January 2006 and January 2021. Preoperative neuropsychological assessment served as inclusion criteria. Language was evaluated according to the BDAE (Boston diagnostic aphasia examination) and WAB (Western aphasia battery) and strength according to the MRC (Medical Research Council) motor scale in the preoperative, immediate postoperative, and 3-months follow up. Functional MRI and tractography depicting white-matter tracts, neuronavigation, cortical and subcortical stimulation were performed in all cases. Conscious sedation was the anesthetic technique (propofol, fentanyl, and NSAIDs). Minimum follow-up was 6 months. FINDINGS The average age was 35 years (16–74). The anatomopathological findings were: low-grade glioma in 75,8% (n = 44), high-grade glioma in 15,6% (n = 9) and others in 8,6% (n = 5). No complications were registered during postoperative course. At the immediate postoperative evaluation 65% of patients presented with speech disturbances but at the 3-months follow up speech recovery was observed in all cases. Only 1 patient remained with moderate aphasia. mRS score at 3- months follow up was ≤ 1 in 96% of patients. Two patients had a persistent moderate hemiparesis. CONCLUSION Tumor resection in awake patients showed to be a safe procedure, and well tolerated by the patients. Preoperative planning of anatomical and functional aspects and intraoperative neurophysiological assessment are the cornerstones for pursuing maximal safe resection.

Oral Impacts of Aligners versus Fixed Self-Ligating Lingual Orthodontic Appliances

The aim of this prospective study was to compare a fixed lingual orthodontic appliance with a commonly used aligner system, focusing on oral impacts and speech disturbances, during the first 3 months of orthodontic treatment. Two groups of adults were evaluated: 21 treated with Invisalign® and 26 with In-Ovation L® lingual brackets. Health-related quality of life questionnaires were used to assess the oral impacts, and speech samples were collected for speech evaluation by professionals. The levels of pain and painkiller intake were similar, increasing on the first day, and decreasing at 3 months. Subtle injuries on the lip and cheeks were initially reported in the aligner group. Lingual patients experienced more discomfort in swallowing and opening the mouth, tongue injuries and food residues, even at 3 months. The consonants “s” and “z” were mainly affected in both groups immediately after appliance insertion, but more often in the aligner group. These speech disturbances recovered in the following 3 months. In conclusion, both groups reported disturbances in quality-of-life measures; however, patients wearing lingual appliances experienced more disturbances, which persisted after three months. Speech disturbances were slightly more pronounced in the aligner group and recovered after three months.

Investigating the diagnostic utility of speech patterns in schizophrenia and their symptom associations

BackgroundSpeech disturbances are a recognised aspect of schizophrenia that may have potential utility as a diagnostic indicator. Recent advances in quantitative speech assessment methods have led to more reproducible and precise metrics making this possible. The current study sought firstly to characterise the speech profile of schizophrenia patients using quantitative speech measures, then examine the diagnostic utility of these measures and explore their relationship to symptoms. MethodsSpeech recordings from 43 schizophrenia/schizoaffective disorder (SZ) patients and 46 healthy controls (HC) were obtained and transcribed. Cognitive and symptom measures were also administered. ResultsCompared to HCs, SZ patients had higher incidences of aberrance across five types of quantitative speech variables: utterances, single words, time/speaking rate, turns and formulation errors, but not pauses. Based on two machine learning algorithms, 21 speech variables across the same five speech variable types (again not including pauses) were identified as significant classifiers for a schizophrenia diagnosis with 90-100% specificity and 80-90% sensitivity for both models. Selective relationships were also observed between these speech variables and only positive, disorganisation, excitement and formal thought disorder symptoms. ConclusionsThe findings support pervasive speech impairments in schizophrenia patients relative to HCs, and the potential diagnostic utility of these speech disturbances. Continued work is needed to build the evidence base for quantitative speech assessment as a future objective diagnostic tool for schizophrenia. It holds the promise of improved diagnostic accuracy leading to increased treatment efficacy and better patient outcomes.

Clinical patterns of cerebral palsy with complications and neurodisabilities associated with cerebral palsy

Cerebral palsy was a primary neuromotor disorder that affects the development of movement, muscular tone and posture due to injury to the developing brain in prenatal, natal, or post-natal period. cp is non progressive disease but it is changeable features with period. The objective of this study is to identify clinical types of cerebral palsy and neuro-disabilities associated with cerebral palsy patient. Data (2019-2020) on 100 children of cerebral palsy in central teaching hospital in Baghdad analysis include clinical patterns of cerebral palsy and topographic classification of spastic cerebral palsy. also, the complication and neurological disabilities associated with cerebral palsy. In this analysis found most of cerebral palsy patients (84%) were spastic according to topographic classification, (47%) of spastic cerebral palsy was diplegic type. (29%) quadriplegic cerebral palsy and (8%) of hemiplegic cerebral palsy. About neurological complication and disabilities associated with cerebral palsy, (79%) of cerebral palsy patients had speech disturbance. (53%) had epilepsy, (43%) Micro acephaly, (32%) of patients had growth retardation, (29 %) had ocular problems, and (15%) of cerebral palsy patients had mental retardation. In conclusions; the most common type of cerebral palsy was spastic cerebral palsy & according to a topographic classification diplegic spastic cerebral palsy was the most common type of Spastic cerebral palsy. About neurodisabilities associated with cerebral palsy, the most common disabilities were speech disturbance and epilepsy.

Genotype-Phenotype Relations in Primary Familial Brain Calcification: Systematic MDSGene Review.

This systematic MDSGene review covers individuals with confirmed genetic forms of primary familial brain calcification (PFBC) available in the literature. Data on 516 (47% men) individuals, carrying heterozygous variants in SLC20A2 (solute carrier family 20 member 2, 61%), PDGFB (platelet-derived growth factor subunit B, 12%), XPR1 (xenotropic and polytropic retrovirus receptor, 16%), or PDGFRB (platelet-derived growth factor receptor beta, 5%) or biallelic variants in MYORG (myogenesis-regulating glycosidase, 13%) or JAM2 (junctional adhesion molecule 2, 2%), were extracted from 93 articles. Nearly one-third of the mutation carriers were clinically unaffected. Carriers of PDGFRB variants were more likely to be clinically unaffected (~54%), and the penetrance of SLC20A2 and XPR1 variants (<70%) was lower in comparison to the remaining three genes (>85%). Among the 349 clinically affected patients, 27% showed only motor and 31% only nonmotor symptoms/signs, whereas the remaining 42% had a combination thereof. While parkinsonism and speech disturbance were the most frequently reported motor manifestations, cognitive deficits, headache, and depression were the major nonmotor symptoms/signs. The basal ganglia were always calcified, and the cerebellum, thalamus, and white matter contained calcifications in 58%, 53%, and 43%, respectively, of individuals. In autosomal-dominant PFBC, mutation severity influenced the number of calcified brain areas, which in turn correlated with the clinical status, whereby the risk of developing symptoms/signs more than doubled for each additional region with calcifications. Our systematic analysis provides the most comprehensive insight into genetic, clinical, and neuroimaging features of known PFBC forms, to date. In addition, it puts forth the penetrance estimates and newly discovered genotype-phenotype relations that will improve counseling of individuals with mutations in PFBC genes. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Progressive Cognitive Decline With Bithalamic and Basal Ganglia Lesions Caused by Dural Arteriovenous Fistula.

A 55-year-old previously healthy man was admitted because of a 3-month history of progressive cognitive decline with Mini-Mental State Examination score 17, characterized mainly by apathy, memory impairment, speech disturbances, anosognosia, and hypersomnia. MRI revealed engorged veins and T2 hypersignal in bilateral thalamus and basal ganglia, with no restricted diffusion on diffusion-weighted imaging (Figure 1). Angiography revealed an anterior skull base dural arteriovenous fistula (DAVF) draining through the inferior sagittal sinus to the internal cerebral and basal vein of Rosenthal with straight sinus occlusion (Figure 2). The clinical picture is explained predominantly by bithalamic venous congestion due to the DAVF and occlusion of the straight sinus.1,2

A Long-term Follow-up of Mandibular Deviation Caused by Congenital Cervical Lymphangioma Treated with an Orthodontic Approach

To report a treatment case of mandibular deviation caused by congenital cervical lymphangioma with traditional orthodontic techniques, following-up by 10-year retention. Lymphangiomas, developmental anomalies, can induce various disturbances of swallowing, mastication, speech, breathing, and skeletal deformities as well as psychological stress and anxiety for the patient and their family. Lymphangiomas are benign with virtually no possibility of turning into a malignant lesion, so clinical management aims to treat the patient functionally. A girl, aged 6 years and 4 months, complained about facial asymmetry and anterior crossbite caused by congenital cervical lymphangioma. Her facial profile was the straight type with an adequate lip position. Anterior and right-side posterior crossbites were observed. On the frontal cephalogram, the menton shifted 3.0 mm to the right. A functional appliance with an expander was placed to correct her dental midline deviation and posterior crossbite. After 2-year treatment, the anterior and right-side posterior crossbites were improved. Multibracket treatment began after the growth spurt. After 44-month active treatment, a functional occlusion, including a Class I molar relationship with a proper interincisal relationship, was achieved. A functional occlusion was maintained during a 10-year retention period, while a mandibular downward growth was observed through the retention period. Conventional orthodontic techniques enable functional and stable occlusion even in patients with mandibular deviation caused by congenital cervical lymphangioma, although only using early orthodontic management by itself may have some limitations. The hybrid technique combining functional appliance and intermaxillary elastics proves to be an effective therapy for correcting occlusal cant and mandibular deviation caused by cervical lymphangioma.

Understanding Parkinson’s Disease (PD) in Ayurvedic Prospective

Parkinson’s disease (PD) known as Kampavata in Ayurveda, is a degenerative neurological disorder of central nervous system, mainly affecting the motor system. It is the major cause of disability in the aging society, which usually affects after the age of 50 years. This disease is increasing in its frequency with the world population showing an incidence of 1-2 per 1000 population and has equal sex distribution. Symptoms like Kampa (Tremor), Stambha (Rigidity), Chestasanga (Bradykinesia and Akinesia), Vakvikriti (disturbance in speech) etc were described in different contexts of Charaka Samhita, Susruta Samhita and Basavarajeeyam. There is no cure for Parkinson’s disease, but medications, surgery and multidisciplinary management can provide relief and improve the quality of life of the individual. In the treatment aspect, the drug L-Dopa has shown better results similarly Ayurvedic drugs having the similar compounds are useful in this disorder. Based on the symptoms manifested, the disease can be correlated to Kampavata mentioned in Ayurveda classics. Despite of so many advances in the field of medicine, treatment of PD remains highly symptomatic. This instills the need for Ayurvedic management of Kampavata. The present article is intended to focus on the Nidana, Lakshanas, Samprapthi and the management principles of Parkinson’s disease (Kampavata).

Primary Extra-axial Glioblastoma: Case Report and Literature Review

AbstractGlioblastoma multiforme (GBM) is the most frequent and most aggressive primary brain tumor in adults, mainly located in the cerebral hemispheres. In the literature, few cases of primary GBM have been reported to have radiographic and intraoperative features of extra-axial lesions, leading to a diagnostic dilemma. Despite the advances in imaging modalities, the diagnosis of GBM can be challenging, and it is mainly based on the histopathologic confirmation of the excised tumor. We describe the case of a 76-year-old previously healthy female patient who presented to our hospital due to speech disturbances and cognitive impairment. The diagnosis of the tumor type on magnetic resonance imaging (MRI) was difficult, as the findings were suggestive of a malignant meningioma due to the heterogeneous enhancement of a dural-based mass with a dural tail sign. Moreover, the intraoperative findings revealed an extra-axial mass attached to the dura. A histological examination confirmed the diagnosis of glioblastoma with arachnoid infiltration. The patient underwent adjuvant radiotherapy and concomitant temozolomide treatment, she had clinical improvement postoperatively, and was stable during the six months of follow-up. Glioblastoma should be considered in the differential diagnosis of primary extra-axial mass with atypical and malignant features, especially in elderly patients.

Clinical Feature, Cause and Outcome in Female Paediatric Child with Osseomuscular Type of Wilson’s Disease

Introduction: Genetically inherited diseases have grown in the last few decades. Wilson’s disease is one of those, named after the U.S.-born British neurologist Dr. Samuel Alexander Kinnier Wilson.&#x0D; Case Presentation: A 12 years old female child was admitted in A.V.B.R. hospital with the chief complaints of altered behaviour, speech disturbances, no physical coordination, uncontrolled movement since 2 to 3 months and fever since 2-3 days. Golden brown eye discoloration was present. After physical examination and investigation doctor diagnosed it as a case of Wilson’s disease.&#x0D; The Main Diagnosis, Therapeutic Intervention and Outcomes: After physical examination and investigation doctor diagnosed this as a case of Wilson’s disease. Zinc and vitamin supplements were given for 7 days to enhance immunity. Beta-blocker was given For 7days twice a day, Tab. Trietinine 250 mg was given once a day for 7 days to remove the heavy metal i.e. copper. She took all treatment and outcome was good. Her signs and symptoms got reduced and she was able to do her routine activities.&#x0D; Conclusion: The diagnosis of Wilson's disease relies largely on clinical examination and laboratory confirmation of abnormal metabolism of copper. This case responded well to all treatment and her recovery was good.

Brain changes underlying progression of speech motor programming impairment.

Aquired apraxia of speech is a disorder that impairs speech production, despite intact peripheral neuromotor function. Its pathomechanism remains to be established. Neurodegenerative lesion models provide an unequalled opportunity to explore the neural correlates of apraxia of speech, which is present in a subset of patients diagnosed with non-semantic variants of primary progressive aphasia. The normalized pairwise variability index, an acoustic measure of speech motor programming, has shown high sensitivity and specificity for apraxia of speech in cross-sectional studies. Here, we aimed to examine the strength of the pairwise variability index and overall word duration (i.e. articulation rate) as markers of progressive motor programming deficits in primary progressive aphasia with apraxia of speech. Seventy-nine individuals diagnosed with primary progressive aphasia (39 with non-fluent variant and 40 with logopenic variant) and 40 matched healthy controls participated. Patients were followed-up annually (range 1–6 years, median number of visits = 2). All participants completed a speech assessment task and a high-resolution MRI. Our analyses investigated trajectories of speech production (e.g. pairwise variablity index and word duration) and associations with cortical atrophy in the patients. At first presentation, word duration differentiated the nonfluent and logopenic cases statistically, but the range of scores overlapped substantially across groups. Longitudinally, we observed progressive deterioration in pairwise variability index and word duration specific to the non-fluent group only. The pairwise variability index showed particularly strong associations with progressive atrophy in speech motor programming brain regions. Of novelty, our results uncovered a key role of the right frontal gyrus in underpinning speech motor programming changes in non-fluent cases, highlighting the importance of right-brain regions in responding to progressive neurological changes in the speech motor network. Taken together, our findings validate the use of a new metric, the pairwise variability index, as a robust marker of apraxia of speech in contrast to more generic measures of speaking rate. Sensitive/specific neuroimaging biomarkers of the emergence and progression of speech impairments will be useful to inform theories of the pathomechanisms underpinning impaired speech motor control. Our findings justify developing more sensitive measures of rhythmic temporal control of speech that may enable confident detection of emerging speech disturbances and more sensitive tracking of intervention-related changes for pharmacological, neuromodulatory and behavioural interventions. A more reliable detection of speech disturbances has relevance for patient care, with predominance of progressive apraxia of speech a high-risk factor for later diagnosis of progressive supranuclear palsy or corticobasal degeneration.

Recanalization strategies in childhood stroke in Germany

Childhood arterial ischemic stroke (CAIS) is a rare event. Diverse etiologies, risk factors, symptoms and stroke mimics hamper obtaining a fast diagnosis and implementing immediate recanalization strategies. Over a period of 3 years (2015–2017), the data of 164 pediatric patients (> 28 days of life-18 years) with a first episode of AIS were submitted to a hospital-based nationwide surveillance system for rare disorders (ESPED). We report a subgroup analysis of patients who have undergone recanalization therapy and compare these data with those of the whole group. Twenty-eight patients (17%) with a median age of 12.2 years (range 3.3–16.9) received recanalization therapy. Hemiparesis, facial weakness and speech disturbance were the main presenting symptoms. The time from onset of symptoms to confirmation of diagnosis was significantly shorter in the intervention group (4.1 h vs. 20.4 h, p ≤ 0.0001). Only in one patient occurred a minor bleed. Cardiac disease as predisposing risk factor was more common in the recanalization group. Recanalization therapies are feasible and increasingly applied in children with AIS. High awareness, timely diagnosis and a large amount of expertise may improve time to treatment and make hyperacute therapy an option for more patients.

European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack.

The aim of the present European Stroke Organisation Transient Ischaemic Attack (TIA) management guideline document is to provide clinically useful evidence-based recommendations on approaches to triage, investigation and secondary prevention, particularly in the acute phase following TIA. The guidelines were prepared following the Standard Operational Procedure for a European Stroke Organisation guideline document and according to GRADE methodology. As a basic principle, we defined TIA clinically and pragmatically for generalisability as transient neurological symptoms, likely to be due to focal cerebral or ocular ischaemia, which last less than 24 hours. High risk TIA was defined based on clinical features in patients seen early after their event or having other features suggesting a high early risk of stroke (e.g. ABCD2 score of 4 or greater, or weakness or speech disturbance for greater than five minutes, or recurrent events, or significant ipsilateral large artery disease e.g. carotid stenosis, intracranial stenosis). Overall, we strongly recommend using dual antiplatelet treatment with clopidogrel and aspirin short term, in high-risk non-cardioembolic TIA patients, with an ABCD2 score of 4 or greater, as defined in randomised controlled trials (RCTs). We further recommend specialist review within 24 hours after the onset of TIA symptoms. We suggest review in a specialist TIA clinic rather than conventional outpatients, if managed in an outpatient setting. We make a recommendation to use either MRA or CTA in TIA patients for additional confirmation of large artery stenosis of 50% or greater, in order to guide further management, such as clarifying degree of carotid stenosis detected with carotid duplex ultrasound. We make a recommendation against using prediction tools (eg ABCD2 score) alone to identify high risk patients or to make triage and treatment decisions in suspected TIA patients as due to limited sensitivity of the scores, those with score value of 3 or less may include significant numbers of individual patients at risk of recurrent stroke, who require early assessment and treatment. These recommendations aim to emphasise the importance of prompt acute assessment and relevant secondary prevention. There are no data from randomised controlled trials on prediction tool use and optimal imaging strategies in suspected TIA.

MO232BORTEZOMIB INDUCED PERIPHERAL AND CENTRAL NEUROPATHY : ABOUT 3 CASE REPORTS

Abstract Background and Aims Bortezomib is a proteasome inhibitor, whose efficacy in the treatment of multiple myeloma has been proven over the last years. However, its side effects may cause concern for patients as well as physicians. We focused in this study on Bortezomib-induced neuropathy, one of the most frequent complications. We present 2 cases of peripheral sensory neuropathy and one intriguing case of central neurological manifestation, all caused by Bortezomib administration. Case 1 A 62-year-old man, with a history of diabetes and hypertension, was diagnosed with multiple myeloma in 2019. He received 2 cycles of Bortezamib (2,5 mg), Dexamethasone , and Cyclophosphamide. Each cycle included 4 doses of Bortezomib, and the cycles were 21 days apart. At the end of the second cycle the patient developed posterior cord syndrome with balance disorder and lower extremities paresthesia. Axonal sensitivo-motor polyneuropathy was confirmed by electromyography. A pharmacology investigation was conducted, and the symptoms were attributed to Bortezomib toxicity. Evolution was favourable after change in protocol to Revlimide. No recurrence was noted. Case 2 A 64-year-old man with no prior history was diagnosed with multiple myeloma in 2020. She received a protocol of 4 cycles, 21 days apart, of Bortezomib (2.1 mg) ,Dexamethasone and Thalidomide . Three weeks after the first cycle, the patient presented with confusion, gait disturbance and four-limb pyramidal deficiency syndrome. Electromyography showed axonal sensitivo-motor polyneuropathy .In the absence of other causes, Bortezomib toxicity was suspected and the patient underwent an emergency epurative hemodialysis session, after which symptoms completely disappeared. Bortezomib doses were then reduced. The evolution was favourable. Case 3 A 50-year-old woman was diagnosed with multiple myeloma in 2018 with Randall's disease and quadri-pyramidal syndrome. She was put on 4 courses of Bortezomib 2.4mg Cyclophosphamide and Dexamethasone, 21 days apart. After 2 coursess, she presented a generalized tonic-clonic seizure preceded by headache, dizziness and followed by speech disturbances. Biological screening for metabolic disorders and toxins was unremarkable. Cerebral MRI showed no abnormalities. Doses of Bortezomib were reduced during the following course. We then witnessed an improvement in speech and no recurrence of seizures. Conclusion Bortezomib induced neuropathy is a serious and debilitating complication to which physicians must pay special attention. This side effect can be managed by dose reduction or change of molecules. Outcomes are often favourable.