Acquired aphasia in children

Language disorders in children with central nervous system injury

Children with injury to the central nervous system (CNS) exhibit a variety of language disorders that have been described by members of different disciplines, in different journals, using different descriptors and taxonomies. This paper is an overview of language deficits in children with CNS injury, whether congenital or acquired after a period of normal development. It first reviews the principal CNS conditions associated with language disorders in childhood. It then describes a functional taxonomy of language, with examples of the phenomenology and neurobiology of clinical deficits in children with CNS insults. Finally, it attempts to situate language in the broader realm of cognition and in current theoretical accounts of embodied cognition.

HEMISPHERIC INTEGRATIVE THERAPY IN LANDAU-KLEFFNER SYNDROME: APPLICATIONS FOR REHABILITATION SCIENCES

A case study is presented of a 14-year-old right-handed Caucasian female diagnosed with the Landau-Kleffner Syndrome (LKS) at the age 3 1/2 years. Her LKS symptoms presented with abrupt disruption in language after normal development, electroencephalogram (EEG) brain-wave abnormality, seizure activity, inability to read, and impairment in her motor skills. After 11 years of pharmacological and special education interventions with no significant improvement in any measurable area of function, a multimodal approach using techniques purportedly aimed at facilitating inter-hemispheric communication was provided. At completion of the program, EEG was controlled, reading, language, and auditory processing improved and objective behavioral-social measures improved significantly.

Brain-derived neurotrophic factor and autoantibodies to neural antigens in sera of children with autistic spectrum disorders, Landau-Kleffner syndrome, and epilepsy

BACKGROUND

Brain derived neurotrophic factor (BDNF) elevation in newborn sera predicts intellectual/social developmental abnormalities. Other autoantibodies (AAs) to endothelial cells (ECs) and myelin basic protein (MBP) are also elevated in some children. We tested relationships between BDNF, BDNF AAs, and other AAs in children with these disorders.

METHODS

BDNF levels and IgG/IgM autoantibodies to BDNF, ECs, MBP, and histones were measured in children with autism, childhood disintegrative disorder (CDD), pervasive developmental delay-not otherwise specified (PDD-nos), acquired epilepsy, Landau-Kleffner syndrome (LKS); healthy children (HC), and children with non-neurological illnesses (NNI).

RESULTS

Mean BDNF levels were elevated in children with autism and CDD, (p < or = 0.0002) compared to HC or NNI. Mean IgG and IgM BDNF AAs were elevated in children with autism, CDD and epilepsy (p < or = 0.0005) compared to HC but not to NNI. Mean IgM AA EC titers detected by immunocytochemistry were higher in autism, PDD-NOS, epilepsy, and LKS (p < or = 0.005) compared to HC and NNI. While mean ELISA IgG EC AAs were higher in autism and PPD-NOS (p < 0.005) compared to HC but not NNI, ELISA IgM EC AAs were higher in children with autism, CDD, PDD-NOS, and epilepsy compared to both HC and NNI (p < 0.0005). Mean anti-MBP IgG and IgM titers were higher in all study groups (p < 0.005) except for LKS compared to both HC and NNI.

CONCLUSION

Children with developmental disorders and epilepsy have higher AAs to several neural antigens compared to controls. The presence of both BDNF AAs and elevated BDNF levels in some children with autism and CDD suggests a previously unrecognized interaction between the immune system and BDNF.

Frühkindlicher Autismus: Alter bei Beginn und frühe Abbauprozesse

Zusammenfassung: Fragestellung: Das Alter bei Beginn autistischer Auffälligkeiten und frühe Abbauprozesse im sozialen oder sprachlichen Bereich werden bei Kindern mit frühkindlichem Autismus als Hinweis auf eine spezielle Untergruppe angesehen. Angaben zur Häufigkeit variieren in den verschiedenen Arbeiten. Ziel der Untersuchung ist es, an einer klinischen Stichprobe festzustellen, wie häufig ein Beginn nach dem ersten Lebensjahr oder Abbauprozesse im sozialen und sprachlichen Bereich beobachtet werden und mit welchen weiteren Auffälligkeiten sie kombiniert sind. Methode: Den Akten von 101 Kindern, die seit 1993 mit der Diagnose eines frühkindlichen Autismus in einer Spezialambulanz untersucht wurden, entnahmen wir die Diagnosen auf den sechs Achsen des multiaxialen Klassifikationssystems, Angaben zum Alter bei Beginn der Auffälligkeiten bzw. des Abbaus und zum Alter bei der 1. Untersuchung. Ergebnisse: 75% der Kinder werden als von Anfang an auffällig beschrieben. 14 der 101 Kinder zeigten einen Abbau im sozialen Bereich und 21 Kinder einen Verlust sprachlicher Fähigkeiten. Ein Zusammenhang mit dem IQ oder dem Sprachentwicklungsstand bei der Untersuchung wurde nicht gefunden. Kinder mit Abbauprozessen hatten häufiger eine Epilepsie als Kinder ohne berichtete Abbauprozesse. Schlussfolgerungen: Die vorhandenen Daten berechtigen zu der Hypothese, dass der verspätete Beginn der autistischen Symptomatik, insbesondere aber der Verlust von Fähigkeiten, ein Hinweis auf eine spezielle Untergruppe innerhalb der autistischen Kinder ist. Diese Symptome sollten unbedingt zu einer genauen diagnostischen Abklärung einer epileptischen Genese führen.

Clinical spectrum of cortical dysplasia in childhood: diagnosis and treatment issues

Disorders of cortical development form a spectrum of lesions produced by insults to the developing neocortex. These conditions typically first manifest in childhood with epilepsy, developmental delay, and focal neurologic signs. Although the clinical and electrophysiologic findings are often nonspecific, high-resolution magnetic resonance imaging facilitates diagnosis during life, and assists in delineating specific clinical syndromes. While many patients are dysmorphic and severely affected by mental retardation and epilepsy, some have normal or near-normal cognitive function and no seizures. Molecular studies of dysplastic cortex are providing new insights into the basic mechanisms of brain function and development, while pathologic analysis of tissue removed at surgery is helping to define epileptic circuitry. Treatment of the epilepsy associated with cortical dysplasia is often frustrating, but surgical approaches based on accurately defining epileptogenic regions are proving increasingly successful. Genetic diagnosis is important for accurate counseling of families.

Serum autoantibodies to brain in Landau-Kleffner variant, autism, and other neurologic disorders

OBJECTIVE

Etiologically unexplained disorders of language and social development have often been reported to improve in patients treated with immune-modulating regimens. Here we determined the frequency of autoantibodies to brain among such children.

DESIGN

We collected sera from a cohort of children with (1) pure Landau-Kleffner syndrome (n = 2), (2) Landau-Kleffner syndrome variant (LKSV, n = 11), and (3) autistic spectrum disorder (ASD, n = 11). None had received immune-modulating treatment before the serum sample was obtained. Control sera (n = 71) were from 29 healthy children, 22 with non-neurologic illnesses (NNIs), and 20 children with other neurologic disorders (ONDs). We identified brain autoantibodies by immunostaining of human temporal cortex and antinuclear autoantibodies using commercially available kits.

RESULTS

IgG anti-brain autoantibodies were present in 45% of sera from children with LKSV, 27% with ASD, and 10% with ONDs compared with 2% from healthy children and control children with NNIs. IgM autoantibodies were present in 36% of sera from children with ASD, 9% with LKSV, and 15% with ONDs compared with 0% of control sera. Labeling studies identified one antigenic target to be endothelial cells. Antinuclear antibodies with titers >/=1:80 were more common in children with ASD and control children with ONDs.

CONCLUSION

Children with LKSV and ASD have a greater frequency of serum antibodies to brain endothelial cells and to nuclei than children with NNIs or healthy children. The presence of these antibodies raises the possibility that autoimmunity plays a role in the pathogenesis of language and social developmental abnormalities in a subset of children with these disorders.

Electroencephalogram in developmental delay: specific electroclinical syndromes

The electroencephalogram (EEG) plays an important role in the evaluation of a child with developmental delay. An EEG is often required to classify seizures in children with developmental delay. Equally important is the role of the EEG in the identification of specific electroclinical syndromes in children who may or may not manifest seizures. Specific electroclinical syndromes include the acquired epileptiform aphasia syndrome, Landau-Kleffner syndrome, and electrical status epilepticus during slow wave sleep. Other clinical situations where the EEG offers diagnostic and prognostic information, such as subacute sclerosing encephalitis, progressive myoclonus epilepsies, Rett syndrome, and Lennox Gastaut syndrome are also discussed.

Conduction aphasia in a 3-year-old with a left posterior cortical/subcortical abscess

A 3-year-old, right-handed girl developed a conduction-type aphasia following a second generalized seizure in the setting of a developing abscess involving left subcortical and cortical angular gyrus and arcuate fasciculus, and the posterior corpus callosum. The language disorder was fluent, characterized by age appropriate mean length of utterance and syntax, but with markedly reduced spontaneity of output, rapid rate of speech and mild dysarthria. Comprehension was relatively, but not completely spared. Naming, repetition, and reading (letters) were initially markedly impaired. Improvements in naming and repetition were associated with both literal and semantic paraphasias. Writing skills in the form of drawing were spared, but a mild apraxia to verbal command and imitation was initially present. Despite her young age, this child's fluent conduction aphasia and lesion localization were adult-like. Multimodal memory difficulties appeared to underlie what is best described as conduction aphasia.

Acquired childhood dysarthria: review of its clinical presentation

The adult classification of dysarthria correlating with the pathophysiology of the motor systems is usually applied to classify acquired childhood dysarthria. However, the validity of this adult model for children has not been studied systematically. All studies pertaining to analysis of speech features in acquired childhood dysarthria published since 1980 were reviewed. Studies were classified on the basis of neuroradiologic evidence of lesion site and associated motor disorder. This review demonstrates that knowledge of acquired childhood dysarthria is based on a limited number of single case studies, most of which pertain to dysarthria occurring after resection of cerebellar tumor. Definite similarities to adult dysarthria were not evident. Some similarity to acquired childhood dysarthria due to basal ganglia lesions was detected. We conclude that acquired childhood dysarthria requires its own classification.

Review of research on the clinical presentation of acquired childhood aphasia

AIMS

The traditional description of the clinical picture of acquired childhood aphasia (ACA) claims that ACA is invariably nonfluent, that recovery of language disorder is rapid and complete, and that ACA commonly occurs after right hemisphere damage. However, since the late 1970s the publication of several case studies has led to reject this longstanding standard doctrine. This review, which concerns the revised insights into ACA, aims at making an inventory of the recently described aphasic symptomatologies and neuroradiological data.

MATERIAL

The literature on ACA with emphasis on the studies published since 1978.

RESULTS

Recent case studies show a great variety of aphasic symptomatologies including auditory comprehension disorders, paraphasias, neologisms, logorrhoea, jargon, impaired repetition abilities, and a host of linguistic deficits in reading and writing. Not only the typology of the aphasias but also the recently established clinicoradiological correlations appear to resemble those found in adults. Also, recovery from ACA shows to be less complete than previously thought.

CONCLUSION

These findings bear consequences as to theories on cerebral organization of language in childhood. It appears that already in infancy the two cerebral hemispheres are no equal substrate for language representation. Therefore, prognosis and final outcome of ACA are not uniformly favourable.