Index
Aphasia/Dysphasia
- Acquired disruption of language function (expressive or receptive/mixed).
- Can be fluent or non-fluent.
- Causes:
- Brain trauma, stroke, cerebral infections (e.g., herpes simplex encephalitis), neoplasms, and neurodegenerative diseases (e.g., Niemann-Pick disease, adrenoleukodystrophy).
- Frequently coexists with dysarthria and dyspraxia, especially with diffuse brain insults.
Auditory Agnosia
- Difficulty interpreting auditory inputs (speech, environmental sounds).
- Often linked to Landau-Kleffner syndrome (LKS) and other epileptic encephalopathies.
- Can stem from bilateral dysfunction of primary auditory cortical areas.
Clinical Features
- Acute Fluent Aphasia/Dysphasia:
- Manifestations include telegraphic speech, word-finding issues, paraphasia, logorrhea, and semantic/neologistic jargon.
- Non-fluent Aphasia:
- Presents with reduced speech output, effortful speaking, and impaired grammar use.
- LKS typically presents with:
- Sudden auditory agnosia.
- Severe regression in speech and spontaneous language.
- Associated EEG abnormalities (e.g., bitemporal spikes).
Differential Diagnoses:
- Selective mutism, ASD regression, or deafness may mimic aphasia.
- Aphasia in herpes simplex encephalitis may fluctuate with behavioral and personality changes.
Diagnostic Evaluation
- EEG:
- Essential for identifying epileptic encephalopathies like LKS.
- Sleep VEEG often reveals interictal epileptiform discharges.
- Neuroimaging:
- MRI or CT scans help identify strokes, infections, or trauma.
- Functional Brain Imaging:
- Evaluates recovery dynamics and hemispheric reorganization in acquired aphasia.
Prognosis
- Children generally recover better from acquired aphasia than adults, though dysphasic features may persist (e.g., reduced naming, phonetic fluency).
- Recovery linked to hemispheric reorganization, with better outcomes in left hemisphere reintegration.
Management & Intervention
- Multidisciplinary Approach:
- Speech-language therapy to address both spoken and written communication.
- Collaboration with educational staff to mitigate academic impacts.
- Targeted Interventions:
- Focus on pragmatic skills, such as inference-making and understanding metaphors.
- Tools like FOCUS measure communication outcomes under the ICF-CY framework.
- For Severe Speech Impairments:
- Modify psychometric instruments to assess comprehension accurately.
- Develop bespoke tools for children with motor speech limitations (e.g., cerebral palsy).
Long-Term Considerations:
- Tailored support in higher education due to increased linguistic demands.
- Ongoing therapy for traumatic brain injury cases to address cognitive delays in language.
References
Arzimanoglou, A., O'Hare, A., Johnston, M., & Ouvrier, R. (Eds.). (2018). Aicardi's Diseases of the Nervous System in Childhood (4th ed.). Mac Keith Press.