Speech Symptoms Research Articles

Migraine with aura: new understanding from clinical epidemiologic studies

To discuss the consequences of recent clinical data on migraine with aura for clinical practice and future research in the light of new diagnostic criteria for migraine with aura. Migraine with aura is now distinguished from hemiplegic migraine and from basilar migraine. Migraine with typical aura has an aura consisting of visual, sensory, or speech symptoms. The aura symptoms typically develop gradually over 5 or more minutes, last between 5 and 60 minutes and, when more than one symptom is present, they occur in succession. Half-sidedness is typical of visual and sensory symptoms, whereas speech symptoms are typically aphasic, primarily of the Broca type. A visual aura rating scale with a high sensitivity and specificity has been developed to standardize the diagnosis of visual aura. The new classification, the new criteria, and the new knowledge about clinical features of migraine with aura are important both for routine clinical diagnosis and for future research studies. Recent studies of the clinical features of migraine with aura allow a more precise diagnosis and classification than previously possible. A clear distinction between migraine with typical aura, hemiplegic migraine, and basilar migraine is important for genetic and other research studies.

Diagnosis and Treatment of Velopharyngeal Insufficiency

The workup of velopharyngeal insufficiency (VPI) includes speech pathology evaluation and examination of velopharyngeal anatomy and physiology. This study sought to determine whether perceptual speech symptoms were predictive of velopharyngeal closure. A retrospective chart review of patients with VPI following primary palatoplasty was performed. All patients underwent perceptual speech evaluation using the Pittsburgh Weighted Speech Scale (PWSS) and examination of velopharyngeal anatomy by videofluoroscopy. PWSS scores were correlated to velopharyngeal closure. All patients exhibited clinical VPI (PWSS = 5-27). No patient demonstrated complete velopharyngeal closure on videofluoroscopy. Velopharyngeal closure on the lateral view showed a statistically significant, moderate correlation with both the PWSS total score (rs = -0.424; P = 0.03) and the phonation subscore (rs = -0.405; P = 0.04). Although certain aspects of speech are related to velopharyngeal anatomy, speech and videofluoroscopic studies each provide unique information in the workup of VPI. Selection of surgical approach often depends on anatomic factors, and improvement in speech postoperatively indicates successful treatment.

Speech in Children with an Isolated Cleft Palate: A Longitudinal Perspective

To describe articulation and speech symptoms related to velopharyngeal impairment in children born with an isolated cleft palate. Blind assessment of speech at 3, 5, 7, and 10 years of age was performed. Two subgroups were formed based on the results at age 5 years, the no-VPI group and the VPI group, and they were compared with controls. A university hospital. Twenty-six children born with isolated cleft palate. Seventeen children served as controls. Soft palate closure at 7 months and hard palate closure at a mean age of 3 years and 11 months if the cleft extended into the hard palate. Perceptual assessments of four variables related to velopharyngeal function and of articulation errors were performed at all ages. Phonetic transcriptions of target speech sounds were obtained at 5, 7, and 10 years and nasalance scores were obtained at age 10 years. The no-VPI group continued to have no or minor difficulties. The VPI group improved but continued to have moderate velopharyngeal impairment. Both groups differed significantly from the controls at age 10 years. Persistent velopharyngeal impairment, as well as glottal misarticulation, were mostly found in children with the cleft as a part of a syndrome or together with multiple malformations. Small changes in velopharyngeal impairment were found across ages. Improvement seemed to be related to surgical intervention, and persistent problems seemed to be related to the presence of additional multiple malformations or syndromes.

Life with communication changes in Parkinson’s disease

Acoustic and perceptual changes to speech in Parkinson's disease (PD) have been widely studied. Little empirical evidence exists concerning the individual's own perception of changes, the impact these have on their life and coping strategies to deal with them. To establish if, and how, changes in communication impact on the lives of people with PD. In-depth interviews with qualitative analysis of content. Community. Twenty-three men and 14 women with PD. Participants were purposively sampled to give a mix of men, women, family circumstances, stage and duration of PD and severity of speech symptoms. Individuals were interviewed at home. Interviews were transcribed. Emergent themes were identified and fed back to participants for confirmation and clarification. Participants identified changes to voice and articulation. Language changes featured prominently. Four impact themes: (i) interaction with others, (ii) problems with conversations, (iii) feelings about intelligibility and (iv) voice; and four corresponding coping themes (a) helping others understand, (b) managing conversations, (c) monitoring and adjusting and (d) physical strategies emerged. Of main concern was not the nature of speech-voice-language changes, but how these affected self-concept, participation inside and outside the family and family dynamics. Individuals employed a range of fluid coping strategies moving from background withdrawal to foreground striving strategies. Speech and language changes in PD impact upon individual and family life long before frank impairment of intelligibility is apparent. The role of early referral to speech and language therapy is therefore worthy of detailed investigation.

Levodopa addiction in idiopathic Parkinson disease

Levodopa (l-dopa) addiction is uncommon and has been described in parkinsonian1 as well as non-parkinsonian patients.2 We report two patients with idiopathic Parkinson disease (PD) and probable l-dopa addiction. A 57-year-old man, with no prior psychiatric history and a 21-year history of PD, was maintained on l-dopa, which he self-regulated. The patient had no known toxin exposure or family history of PD. Thirteen years after PD diagnosis, he was hospitalized in a psychiatric ward for paranoid delusions and visual hallucinations. While hospitalized, he hoarded l-dopa and ingested up to 5 g a day. He had repeated admissions for psychosis following excess consumption of l-dopa. When psychotic, he became paranoid, agitated, and confused; he carried a camera in order to document the presence of demons and took long walks at night, scantily dressed in female clothing. He developed manic symptoms of rapid speech, decreased sleep, and hypersexuality, masturbating …

Aura with non-migraine headache

The typical aura associated with migraine is characterized by visual or sensory and speech symptoms, with a mix of positive and negative features and complete reversibility within 1 hour. However, auras are not an exclusive migraine-dependent phenomenon. There have been descriptions of aura occurring in association with cluster headache, hemicrania continua, and even with chronic paroxysmal hemicrania. In addition, the occurrence of aura without headache or followed by a headache resembling the criteria of tension-type headache is encountered in clinical practice. This paper reviews the literature about auras in non-migraine headaches and the features involving this uncommon presentation. The possibility of a specific genetic origin for the auras, not related to the primary headache type, also is raised.

The brain, language, and schizophrenia

Language is a defining and prominent feature in humans. This faculty is impaired in those with schizophrenia. Individuals with schizophrenia show numerous abnormalities in language function, including symptoms of disorganized speech, auditory hallucinations, thought disorders, and verbal memory impairments. Structural and functional brain imaging with neurocognitive testing shows various aspects of brain structure and function associated with language that also are abnormal in schizophrenia. This article comparatively reviews this research and relates it to understanding the symptoms and pathophysiologic features of schizophrenia. Understanding the neural basis of language and its disruption in schizophrenia provides a guide for diagnosis, subtyping, treatment, and future research.

Insular Seizures: Have We Been Missing the Boat?

Clinical Manifestations of Insular Lobe Seizures: A Stereo-electroencephalographic Study Isnard J, Guenot M, Sindou M, Mauguiere F Epilepsia 2004;45:1079–1090 Purpose In this study, we report the clinical features of insular lobe seizures based on data from video and stereoelectroencephalographic ictal recordings and direct electric insular stimulation of the insular cortex performed in patients referred for presurgical evaluation of temporal lobe epilepsy (TLE). Methods Since our first recordings of insular seizures, the insular cortex has been included as one of the targets of stereoelectroencephalographic electrode implantation in 50 consecutive patients with TLE whose seizures were suspected to originate from, or rapidly to propagate to, the perisylvian cortex. In six, a stereotyped sequence of ictal symptoms associated with intrainsular discharges could be identified. Results This ictal sequence occurred in full consciousness, beginning with a sensation of laryngeal constriction and paresthesiae, often unpleasant, affecting large cutaneous territories, most often at the onset of a complex partial seizure (five of the six patients). It was eventually followed by dysarthric speech and focal motor convulsive symptoms. The insular origin of these symptoms was supported by the data from functional cortical mapping of the insula by using direct cortical stimulations. Conclusions This sequence of ictal symptoms looks reliable enough to characterize insular lobe epileptic seizures. Observation of this clinical sequence at the onset of seizures on video-EEG recordings in TLE patients strongly suggests that the seizure-onset zone is located not in the temporal but in the insular lobe; recording directly from the insular cortex should occur before making any decision regarding epilepsy surgery.

Longitudinal Course of Schizophrenia Spectrum Symptoms in Offspring of Psychiatrically Hospitalized Mothers

The aim of this study was to describe schizophrenia spectrum symptoms (SZSD) in children and adolescents with schizotypal personality disorder (SPD) as adults. There are no descriptive studies of children who develop into adults with SPD. Twelve offspring of psychiatrically hospitalized mothers (6 mothers with schizophrenia), were compared with 11 socioeconomic status (SES)-matched offspring of control, non-ill mothers. Offspring were evaluated clinically and psychometrically between infancy and 2, 10, 15 years of age, and adulthood. Adult Axis I and II diagnoses were made blind to infant and parent status. Six hospitalized mothers were diagnosed with schizophrenia, 6 with other severe psychopathology. Offspring with SZSD more likely had schizophrenic mothers, and childhood deteriorating IQs, symptoms of social isolation, constricted affect, digressive speech, suspiciousness, and excessive social anxiety. Global assessment scores in SZSD offspring were lower in childhood and adulthood than comparison offspring. Children with SZSD met currently accepted criteria for schizotypy; 3 by 10 years of age, and 2 by 19 years of age. Differential diagnosis is discussed. An appendix of case histories is presented.

Dumbbell trigeminal schwannoma in a child: complete removal by a one-stage pterional surgical approach

The objective was to describe a rare case of a trigeminal schwannoma in a child and the surgical procedure performed for therapy. A 6-year-old girl presented with tiredness, dysarthric speech and cerebellar symptoms. Imaging studies revealed a unilateral dumbbell-shaped tumour, extending into both the middle and posterior fossa, centred over Meckel's cave. One-stage surgery was performed by pterional craniotomy. The tumour was first debulked in the middle fossa, then peeled from the wall of the cavernous sinus, followed by extirpation of the tumour from the posterior fossa. The tumour extended to the caudal cranial nerves and was completely removed. Trigeminal fascicles were distributed throughout the tumour. Histopathological examination revealed a schwannoma. Trigeminal schwannoma is a tumour that occurs rarely in childhood. Although several, often multistaged surgical strategies have been reported in the literature, this tumour was eradicated by a one-stage pterional approach.

The Language of Dissociation

ABSTRACT Three case studies of inner-city elementary school children illustrate the connection between speech-language disorders and dissociative disorders in children who have known or suspected trauma histories. The role of speech language pathologists in identifying and responding to dissociative symptoms in children is explored. Lack of adequate training concerning the impact of trauma and scarce literature on the communication profiles of dissociative children contributes and greatly impacts the diagnosis, referral, and treatment of these children. The case studies demonstrate how unusual speech and language symptoms and awareness of dissociative features may aid in identifying trauma-related problems and instituting effective treatment. Grounding techniques and specific language interventions can assist children in acquiring the vocabulary needed for communicating both their daily experiences and traumatic histories. The nature of the relationship between dissociation and communication disorders is explored, and the importance of future research, interdisciplinary collaboration, and trauma training in the speech-language curriculum is emphasized.

A Foreign Speech Accent in a Case of Conversion Disorder

Objective: The aim of this paper is to report the psychiatric, neuroradiological and linguistic characteristics in a native speaker of Dutch who developed speech symptoms which strongly resemble Foreign Accent Syndrome. Background: Foreign Accent Syndrome is a rare speech production disorder in which the speech of a patient is perceived as foreign by speakers of the same speech community. This syndrome is generally related to focal brain damage. Only in few reported cases the Foreign Accent Syndrome is assumed to be of psychogenic and/or psychotic origin. Method: In addition to clinical and neuroradiological examinations, an extensive test battery of standardized neuropsychological and neurolinguistic investigations was carried out. Two samples of the patient's spontaneous speech were analysed and compared to a 500,000-words reference corpus of 160 normal native speakers of Dutch. Results: The patient had a prominent French accent in her pronunciation of Dutch. This accent had persisted over the past eight years and has become progressively stronger. The foreign qualities of her speech did not only relate to pronunciation, but also to the lexicon, syntax and pragmatics. Structural as well as functional neuroimaging did not reveal evidence that could account for the behavioural symptoms. By contrast psychological investigations indicated conversion disorder. Conclusions: To the best of our knowledge this is the first reported case of a foreign accent like syndrome in conversion disorder.

Chronic ‘speech catatonia’ with constant logorrhea, verbigeration and echolalia successfully treated with lorazepam: a case report

Logorrhea, verbigeration and echolalia persisted unremittingly for 3 years, with occasional short periods of motoric excitement, in a patient with mild intellectual handicap suffering from chronic schizophrenia. The speech catatonic symptoms, previously refractory to various antipsychotics, responded promptly to lorazepam, a benzodiazepine with documented efficacy in the treatment of acute catatonia but not chronic catatonia. It is suggested that pathways in speech production were selectively involved in the genesis of the chronic speech catatonic syndrome, possibly a rare form of chronic catatonia not previously described.

Preventing Disturbing Migraine Aura With Lamotrigine: An Open Study

Lamotrigine has been suggested as possibly effective for preventing migraine aura. To describe our experience with a series of patients with disturbing migraine aura treated with lamotrigine. The members of the Headache Group of the Spanish Society of Neurology were sent an ad hoc questionnaire to collect patients treated with lamotrigine due to disturbing migraine aura. The main outcome parameter ("response") was a >50% reduction in the mean frequency of migraine auras at 3 to 6 months of treatment. A total of 47 patients had been treated with lamotrigine due to severe migraine aura. Three could not complete the protocol as a result of developing skin rashes. Thirty (68%) patients responded. These were 21 females and 9 males whose ages ranged from 19 to 71 years. Eight suffered from migraine with "prolonged" aura, 8 typical aura with migraine headache (but had frequent episodes including speech symptoms), 6 basilar-type migraine, 6 typical aura without headache, and 2 hemiplegic migraine. Fifteen had been previously treated, without response, with other preventatives. The mean monthly frequency of migraine auras in these 30 patients changed from 4.2 (range: 1 to 15) to 0.7 (range: 0 to 6). Response was considered as excellent (>75% reduction) in 21 cases (70% of responders). Auras reappeared in 2 months in 9 out of 13 patients where lamotrigine was stopped, and ceased as soon as this drug was reintroduced. Lamotrigine should be considered in clinical practice for the preventive treatment of selected patients with disturbing migraine auras. Lamotrigine seems worthy of a controlled trial as prophylaxis of migraine aura.

Mild Cognitive Impairment: Focus on Diagnosis

Great interest is now devoted to elderly people with memory or other cognitive complaints who are not demented. The determination of this impairment from normality is difficult, because memory performance may decline slowly along the lifetime of the individual. On the other hand, the identification of dementia depends on the criteria used for dementia (DSM-IV or ICD-10). Furthermore, cognitive deterioration of the elderly appears to be heterogenous and may forerun not only Alzheimer's disease but also other forms of dementia. By applying a set of criteria for frontotemporal mild cognitive impairment, it was possible to identify, retrospectively, a series of patients with behavioral, affective, or speech symptoms suggestive of frontotemporal dysfunction and deficits in frontal lobe-dependent neuropsychological tests, but who have maintained activities of daily living and are not demented. These patients appear to have a high probability of progressing subsequently to dementia of the frontotemporal type. Several potential neuroprotective compounds are now being subjected to clinical trials. Should they be effective in delaying the progression to dementia, the need to detect and treat elderly people with cognitive impairment will become very important.

Speech outcomes in isolated cleft palate: impact of cleft extent and additional malformations.

The purpose of the study was to study the speech outcome in a series of 5-year-old children born with an isolated cleft palate and compare the speech with that of noncleft children and to study the impact of cleft extent and additional malformation on the speech outcome. A cross-sectional retrospective study. A university hospital serving a population of 1.5 million inhabitants. Fifty-one patients with an isolated cleft palate; 22 of these had additional malformations. Thirteen noncleft children served as a reference group. A primary soft palate repair at a mean of 8 months of age and a hard palate closure at a mean age of 4 years and 2 months if the cleft extended into the hard palate. Perceptual judgment of seven speech variables assessed on a five-point scale by three experienced speech pathologists. The cleft palate group had significantly higher frequency of speech symptoms related to velopharyngeal function than the reference group. There were, however, no significant differences in speech outcome between the subgroup with a nonsyndromic cleft and the reference group. Cleft extent had a significant impact on the variable retracted oral articulation while the presence of additional malformations had a significant impact on several variables related to velopharyngeal function and articulation errors. Children with a cleft in the soft palate only, with no additional malformations, had satisfactory speech, while children with a cleft palate accompanied by additional malformations or as a part of a syndrome should be considered to be at risk for speech problems.

Speech Outcomes in Isolated Cleft Palate: Impact of Cleft Extent and Additional Malformations

Abstract Objective: The purpose of the study was to study the speech outcome in a series of 5-year-old children born with an isolated cleft palate and compare the speech with that of noncleft children and to study the impact of cleft extent and additional malformation on the speech outcome. Design: A cross-sectional retrospective study. Setting: A university hospital serving a population of 1.5 million inhabitants. Subjects: Fifty-one patients with an isolated cleft palate; 22 of these had additional malformations. Thirteen noncleft children served as a reference group. Interventions: A primary soft palate repair at a mean of 8 months of age and a hard palate closure at a mean age of 4 years and 2 months if the cleft extended into the hard palate. Main outcome measures: Perceptual judgment of seven speech variables assessed on a five-point scale by three experienced speech pathologists. Results: The cleft palate group had significantly higher frequency of speech symptoms related to velopharyngeal function...

Diagnosis of AOS: definition and criteria.

Presented in this article is a discussion of current progress in behavioral, cognitive, and neuroanatomic definitions of apraxia of speech (AOS). A behavioral definition summarizes the speech symptoms that should be considered diagnostic of AOS with or without co-occurring aphasia and dysarthria. AOS is defined in cognitive terms as an impairment in the translation of phonological representations into specifications for articulation. Progress toward a neuroanatomic definition of AOS will rely on mapping the processes described by increasingly sophisticated cognitive models of normal speech production to the brain. The article describes criteria that have been proposed for differentiating apraxic from phonological and dysarthric disorders and suggests that syndrome-based approaches to the diagnosis of AOS may obscure important differences between individual presentations of apraxic disruption as well as similarities between AOS and other speech-language disorders.

On manifestations of aphasia in Catalan: a case study of Broca's aphasia

This paper discusses a case of Broca's aphasia in light of the impact of the structure of the patient's mother tongue, Catalan, on the types of errors he makes. What seems to be most affected in the present case, in terms of Kolk's (1995) theory of “structural simplification” —proposed originally for sentence production and comprehension—are those linguistic levels that are most complex in Catalan: closed class word morphology and verb morphology as well as production and comprehension of sentences with non-canonical word order. The types of errors presented always occur in structurally obligatory contexts where the semantic or propositional content of the omitted or misused elements is rather small. Another important fact to bear in mind when studying Catalan aphasics is that, due to the bilingualism of all speakers, some of the signs and symptoms of aphasic speech have to be interpreted in light of the rival language, Spanish.

Identification of symptoms for spasmodic dysphonia and vocal tremor: a comparison of expert and nonexpert judges

Spasmodic dysphonia is a rare voice disorder that is most successfully treated by injection of botulinum toxin (i.e., BOTOX) into the affected laryngeal muscles. BOTOX is currently available for use by professionals outside of metropolitan voice centers who may be unfamiliar with this rare disorder. Patients may seek assessment and treatment locally from clinicians who are unfamiliar with the speech symptoms for adductor-type (ADSD) or abductor-type (ABSD) spasmodic dysphonia. Although these disorders have been described in the literature, the symptoms have not been well defined and may appear similar to those of vocal tremor or muscle tension dysphonia (MTD). Thus, patients with spasmodic dysphonia might not be easily identified by local clinicians for treatment. The purpose of the current study was to determine whether voice clinicians with infrequent exposure to patients with spasmodic dysphonia could learn to identify speech symptoms for ADSD and ABSD comparable to voice clinicians with extensive experience with these disorders. The ratings of five nonexpert judges were compared to the ratings obtained from three expert judges. The results of this study demonstrated that nonexpert judges could be trained to identify the speech symptoms associated with ADSD, ABSD, and vocal tremor. While the nonexpert judges tended towards false positive judgements for the speech symptoms of interest, the overall speech symptom profiles for each type of voice disorder appeared comparable to those obtained from the expert judges. The symptom identification scales used, therefore, have potential for use by clinicians unfamiliar with these disorders for correctly identifying persons with symptoms of ADSD and ABSD. Educational objectives: Readers will be able to (1) define the predominant speech symptoms reflective of the voice disorder categories of ABSD, ADSD, and vocal tremor; and (2) describe the methods utilized in a new perceptual training protocol for teaching clinicians how to identify predominant speech symptoms associated with the voice disorder categories of ABSD, ADSD, and vocal tremor.