Foreign accent syndrome is a rare phonological disorder in which, as a result of central nervous system damage, the patient’s speech resembles a foreign dialect. Sounds acquire the phonetic coloring of another language, accents and prosodic components change. In general, speech remains semantically and grammatically correct. Diagnostics involves the use of neuroimaging methods, neuropsychological testing, speech therapy examination, linguistic analysis. The treatment is aimed at correcting the underlying disease that caused the language disorder. Logotherapy is used to eliminate the accent.
ICD 10
F80.0 Specific disorder of speech articulation
General information
Foreign accent syndrome (FAS) is a motor speech disorder in which a patient develops a language accent markedly different from a premorbid dialect. The pathological phenomenon was described at the beginning of the last century by the French neurologist P. Marie. In 1907, he observed a patient who suddenly developed an Alsatian accent after a stroke. To date, there are reports of more than 100 episodes of this syndrome in the world. Women are more likely to suffer from the disorder, the average age of the appearance of a foreign accent is 25-50 years. The overwhelming majority of patients are right-handed.
Causes
The available clinical observations make it possible to rank the causes of foreign accent syndrome depending on their significance. In all cases, the development of FAS is based on neurological or mental disorders. The most likely causes:
- Head injuries. Traumatic brain injuries are the first most common cause of FAS. Speech motor disorders can be the result of severe concussions and brain contusions, open TBI, and neurosurgical interventions. They usually develop against the background of a previous loss of consciousness or a comatose state.
- Brain strokes. The appearance of a foreign accent is regarded as an atypical manifestation of ACVA. Most often, the condition develops as a result of cerebral lesions of the left hemisphere. The damage zone includes the premotor and motor areas, Broca’s center, basal ganglia, and cerebellum.
- Brain tumors. They cause speech dysfunction both due to direct pressure on the brain substance and due to the germination of cerebral structures. There is a known case when FAS developed after resection of a giant oligoastrocytoma located in the left insular lobe involving the frontotemporal region.
- Demyelinating diseases. A characteristic speech disorder in multiple sclerosis is cerebellar dysarthria, accompanied by chanted speech. However, in some cases, rhinophony, phonetic distortions, dysprosody may appear.
- Mental disorders. FAS occurs in the clinic of a number of pathopsychological syndromes: hysterical psychosis, bipolar affective disorder, Asperger’s syndrome, PTSD. An observation is described when an American suffering from schizophrenia had a British accent in his speech during periods of exacerbation: the more severe the relapse, the more pronounced the pronunciation features were.
There are isolated reports of cases of foreign accent syndrome associated with severe migraine, arteriovenous malformation of the brain, surgical intervention on the jaw area.
Pathogenesis
As a result of cerebrovascular, tumor, traumatic, neurodegenerative pathologies, damage to the motor cortical divisions, subcortical structures, and the cerebellar region occurs. These departments are responsible for the implementation of various aspects of language activity: articulation, phonology, prosody, etc. The defeat of these areas causes articulatory dyspraxia, the breakdown of the kinetic melody of the word and the rhythmic-melodic structure of speech as a whole.
At the same time, there are minimal articulatory disorders that others regard as a foreign accent. Speech intonation, emotionality, stress, and the placement of pauses also suffer. The manner of expressive speech changes. Grammatical and semantic components, understanding of speech are not violated.
Some researchers consider foreign accent syndrome to be a mild form of speech apraxia, but patients with FAS have the opportunity to better control their motor disorders. That is, a foreign accent acts as a way and form of compensation for their speech deficit.
Classification
In 2010, neurolinguists P. Marien and D. Verhoeven identified several variants of the foreign accent syndrome. The classification of FAS was based on the etiopathogenetic principle:
- neurogenic syndrome – develops as a result of acute or chronic cerebral injuries. It is divided into acquired and evolutionary types (the emphasis is noticeable from an early age);
- psychogenic syndrome – associated with psychological characteristics of the individual or mental disorders;
- mixed syndrome – occurs in neurological diseases, but changes the psychology of personality, affects the awareness of self-identity.
Symptoms
The speech of a patient with foreign accent syndrome has the correct grammatical form, but differs from the premorbid dialect in phonetic and prosodic features. According to its acoustic characteristics, it is perceived by others as a foreign language, unusual for native speakers. Characteristic clinical signs of the syndrome are:
- changing the phonation of vowel sounds: stretching or shortening the phonation time, increasing the degree of tension, pharyngalization, monophthongization of diphthongs (merging two vowels into one phoneme);
- another manner of pronunciation of consonants that is not peculiar to the dialect of the native language (for example, uvular vibration of the tongue instead of alveolar);
- changes in speech intonation: tempo, rhythm, melody, stress, pauses.
Patients with foreign accent syndrome note that they have never been to the regions in whose dialect they begin to speak, and have not had long-term contacts with local residents.
Complications
In studies, people with FAS reported serious psychological problems, difficulties in communicating with others, a sense of loneliness, discrimination on the basis of nationality due to a “foreign” accent. Some patients develop prolonged depression, mutism. These conditions require psychotherapeutic help. In addition, the appearance of a foreign accent may be a sign of an impending mental illness or the central nervous system, so it should not be ignored.
Diagnostics
Since the foreign accent syndrome accompanies the clinic of mental or neurological diseases, the examination should be aimed at clarifying the mechanisms and etiology of the primary disorder. To develop a comprehensive therapeutic approach, it is necessary to conduct pathopsychological and speech therapy diagnostics. Patients with FAS are prescribed:
- Neurological examination. In order to detect morphological changes (areas of ischemia, hemorrhages, tumors, atrophy), a brain MRI or CT scan is performed. The methods of clarifying diagnostics are PET-CT and brain SPECT. Electroencephalography helps to assess the functional activity of the central nervous system.
- Consultation of a psychiatrist/ psychotherapist. It is required for differential diagnosis of neurogenic and psychogenic foreign accent syndrome. Pathopsychological diagnostics, research of personality structure is carried out.
- Consultation of a speech therapist. Examination of various aspects of oral speech (expressive, receptive, grammar, sound pronunciation, vocabulary) allows you to identify the broken links of speech function. Sometimes Broca’s aphasia, dysarthria may be hidden behind the syndrome of a foreign accent.
- Neuro-linguistic diagnostics. For scientific purposes, a study of the language function can be carried out, the exact dialect is determined based on the analysis of prosodic and phonetic characteristics of speech. Phonetography, acoustic analysis of the voice using computer programs is used to objectify the data.
Treatment
No special therapy for FAS has been developed. Usually, its correction is carried out during the treatment of the main pathology: TBI, stroke, cerebral tumors, MS, manic-depressive psychosis, schizophrenia, etc. As part of a comprehensive rehabilitation program, the following methods are used:
- Pharmacotherapy. Patients with cerebrovascular pathology are prescribed hypotensive, anticoagulant, neuroprotective drugs. In the first hours after the development of an ischemic stroke, systemic or selective thrombolysis is effective. Neuroleptics, normotimics, antidepressants, anxiolytics are used for the treatment of mental disorders.
- Psychotherapy. Among the methods of psychotherapeutic treatment, cognitive behavioral therapy and family psychotherapy are used. The priority task is to maintain the social and communicative activity of patients, acceptance of themselves and their characteristics.
- Logotherapy. The purpose of speech therapy classes is to improve motor skills of speech, mastering the correct articulation of sounds, rhythmic pattern of speech. Articulation gymnastics, logomassage, vocalotherapy can be used as auxiliary methods.
Prognosis and prevention
In approximately 25% of patients, the foreign accent syndrome regresses against the background of ongoing treatment. Episodes of remission of FAS usually correspond to remission of the underlying disease and become most pronounced during periods of its exacerbation or progression. To prevent speech disorders, you need to take responsibility for your health: monitor blood pressure and the level of lipidemia in the blood, avoid head injuries, regularly undergo a medical examination. If a foreign accent suddenly appears in speech, you should immediately consult a neurologist.