三种穴位刺激法治疗癔病性失语的疗效观察

目的观察三种穴位刺激法治疗癔病性失语的临床疗效。方法将30例癔病性失语患者随机分为传统针刺组、电针组、穴位电刺激组,每组10例。分别采用传统针刺、电针和低频电穴位刺激治疗,观察各组治疗前后的临床发音情况及胸锁乳突肌的积分肌电值（IEMG）改变情况。结果各组经不同疗程的治疗后,患者均能恢复洪亮清晰的发音,其中以电针组疗程最短,穴位电刺激组次之,传统针刺组最长;癔病性失语的临床有效率与胸锁乳突肌的IEMG呈负性相关;电针疗法在三种穴位刺激法中疗效最优,其次依次为低频电刺激法、传统针刺法。结论胸锁乳突肌IEMG可作为判定癔病性失语临床疗效的一项观察指标而加以运用;在癔病性失语的治疗中,针刺和电兴奋疗法两者配合应用,可起到相得益彰的作用。     

Cortical stimulation mapping in a patient with foreign accent syndrome: case report

Foreign accent syndrome is a rare language output disorder characterized by changes in various speech features leading to a perceived foreign accent. There are few cases reported in the literature. Due to the rarity of this condition, information regarding the functional neuroanatomy of FAS is lacking. We present the case of a 60-year-old woman with a left anterior parietal lobe breast carcinoma metastasis who developed foreign accent syndrome (FAS). This patient presented to the emergency room with right upper extremity weakness, facial weakness, and altered speech. Neurological examination revealed the patient's speech to be dysarthric and accented, but otherwise appropriate. Brain magnetic resonance (MR) imaging demonstrated a 3cm x 3cm x 3cm lesion in the left anterior parietal lobe. The patient underwent craniotomy for resection of the mass. Intra-operative cortical stimulation mapping demonstrated the lesion to be confined to somatosensory cortex and gross total resection was performed. There were no new neurological deficits post-operatively. To our knowledge, this is a unique case of FAS due to breast carcinoma metastasis. Additionally, this is the first documented case of electrocortical function stimulation mapping of language and Rolandic cortex in a patient with FAS.     

Landau-Kleffner syndrome: long-term follow-up

Purpose

Landau–Kleffner syndrome (LKS) is a rare entity characterized by epilepsy and aphasia. It occurs in previously normal children, usually between three and seven years of age. The long-term outcome of LKS is not completely clear. The aim of this study is to verify the long-term follow-up of a group of patients with LKS, focusing on clinical and electroencephalographic (EEG) aspects, and quality of life. Methods: This was a transversal study. Between November 2006 and April 2007 seven patients with previous diagnosis of LKS were interviewed. They had had a follow-up of three to 16 years after their disease onset. They were all males between the ages of eight and 27 years old. All patients had normal MRI. Parents and/or patients were interviewed by one of the authors using a structured questionnaire. The Vineland Adaptive Behavior Scales, the Conner’s Rating Scales – Revised, and Short-Form Health Survey (SF 36) were used. Each patient had a prolonged interictal EEG recording. All patients had normal MRI. Results: The present investigation revealed that two patients still have seizures several years after epilepsy onset. One patient had total and three others had partial remission of language disturbance, while three patients still have aphasia and verbal auditory agnosia. With respect to quality of life, only one of our patients has a normal life at present. The remaining six patients with some sort of limitation consider the aphasia/agnosia to be the main difficulty in their lives. Five patients have normal EEGs. Conclusions: The long-term follow-up of patients with LKS shows that epilepsy and EEG abnormalities do not always disappear. Language disturbances tend to persist in most patients. The age of onset of language dysfunction does not seem to correlate with the prognosis for recovery of language function. Patients with LKS have an overall poor quality of life, mostly due to language difficulties.     

Consciousness and speech evaluation of 96 patients with craniocerebral injury

Objective: To explore the effective methods for evaluating the consciousness and speech status of patients with special types of cerebral injuries.Methods: Atotal of 96 patients with injury in the language center and in coma were treated with operative and correlated conventional therapies. Then their recovery status of consciousness and speech was observed.Results: All the patients were recovered to consciousness. Sixty-nine patients with aphasia were cured completely, but 7 patients were complicated with incomplete ataxic aphasia, 15 with incomplete sensory aphasia,and 5 with incomplete mixed aphasia.Conclusions: For the patients with injury in the language center, evaluation of the conscious state with GCS scoring system has certain limitations and conscious behaviours are advantageous evidences to evaluate the consciousness recovery of the patients. The patients with conscious disturbance and injury in the language center should be considered to have aphasia.     

脑卒中后失语患者抑郁的诊断进展

脑卒中后抑郁发病率高,对患者神经功能的恢复影响较大,越来越引起神经内科医师的重视。但脑卒中后抑郁的诊断尚缺乏特异性的标准,临床中仍参考原发性抑郁的标准进行诊断。由于脑卒中后患者的特殊性,医务人员常无法与其正常交流,影响了脑卒中后抑郁诊断的准确性,因而急需开发合适的非语言依赖的诊断方法。近年来针对脑卒中后失语患者的非语言依赖的诊断量表相继开发,并且有学者正研究适合的生物学指标,以提高脑卒中后抑郁的诊断率。     

脑卒中后失语症患者自然恢复的相关因素分析

目的研究影响脑卒中后失语症患者自然恢复的相关因素。方法103例急性脑卒中后失语症患者分别于急性期及脑卒中后3月进行NIHSS、WAB和BDAE评估,记录患者的各项基本参数及常规检查。结果脑卒中后3月的NIHSS及AQ评分分别为（17．09±5．31）、（54．92±24．49）分较急性期（20．34±4．87）、（33．17±24．21）分明显改善（P〈0．01）;AQ与NIHSS评分均呈负相关（r=-0．478、-0．726、-0．805,P〈0．01）;恢复不良组年龄（76．28±8．58）岁大于恢复良好组（67．09±12．34）岁（P〈0．01）;恢复不良组合并房颤者（7／18）比例高于恢复良好组（8／85）（P〈0．01）;Logistic回归分析显示全面性失语的OR值为6．727（95％CI：2．195-20．62）（P〈0．01）。结论（1）脑卒中3月后大多数患者的语言功能明显改善;（2）年龄大、伴房颤的患者恢复差;（3）全面性失语在脑卒中后的各种类型失语中预后差。     

Different variables predict anomia in different subjects: a longitudinal study of two Alzheimer's patients

Two Alzheimer's patients participated in a longitudinal study of picture naming aimed at analysing the effect of lexical frequency, age of acquisition, stimulus familiarity, word length, name imageability, visual complexity and semantic category membership on naming success. The results were analysed with a new method [Capitani, E., & Laiacona, M. (2004). A method for studying the evolution of naming error types in the recovery of acute aphasia: A single-patient and single-stimulus approach. Neuropsychologia, 42, 613-623] that allows us to consider the consistency of responses to stimuli over repeated testing within clinical stages. The experiment was carried out as a longitudinal study of single cases, and the effect of each variable was estimated after removing the overlap with the other predictors. The semantic category of stimuli was not an influential factor for either patient. Other findings sharply distinguished between the two patients. In one case, disease-related decline consistently affected mainly late acquired names, whereas in the other case the decline affected names corresponding to low-familiarity items. To interpret this contrast, we further analysed the quality of the errors produced by each patient. This study shows that the psycholinguistic characteristics of a stimulus may exert varying influence in different patients, warranting further development of this line of inquiry.     

A comparison of two theoretically driven treatments for verb inflection deficits in aphasia

Errors in the production of verb inflections, especially tense inflections, are pervasive in agrammatic Broca's aphasia (*The boy eat). The neurolinguistic underpinnings of these errors are debated. One group of theories attributes verb inflection errors to disruptions in encoding the verb's morphophonological form, resulting from either a general phonological deficit or a morphological affixation impairment. A second group of theories attribute verb inflection errors to disruptions that arise during sentence formulation, either for syntactic reasons or due to impairments in making fine semantic distinctions between inflectional variants of a verb (+PAST-->ate, hugged; +FUTURE-->will eat, will hug). These morphophonological and morphosemantic accounts were evaluated by comparing the efficacy of two treatment protocols that exclusively targeted either morphophonological operations or morphosemantic distinctions. Using a single participant design, it was found that aphasic individuals who received morphosemantic treatment showed significant improvement in accurate production of trained and untrained verb inflections in sentence contexts. In contrast, individuals who received morphophonological treatment failed to show improvements in accuracy of sentence production, although the number and diversity of inflected verbs increased. The differential outcomes suggest that morphosemantic impairments contribute to verb inflection deficits in agrammatic aphasia to a greater extent than morphophonological impairments, at least in this group of participants.     

Evaluation of quality of life in people with aphasia using a Dutch version of the SAQOL-39

Purpose.?To examine the quality of life (QoL) of people with aphasia and to study the influence of variables such as age, time post onset and (degree of) social support on the QoL of aphasic persons.

Method.?We compared the scores of an aphasic population (N?=?43) with those of a healthy control group (N?=?43) and of a group of patients with brain lesions without neurogenic communication disorders (N?=?43) on a Dutch version of the Stroke and Aphasia Quality of Life-scale (SAQoL-39) and on a social support questionnaire. In half of the aphasic group, the SAQoL-39 was re-administered 8 months after the first testing.

Results.?People with aphasia obtained significantly lower scores for QoL measures compared with both other groups. Especially, communicative and psychosocial factors seem to influence these results. Older people with aphasia scored lower than younger persons and women tend to evaluate their QoL somewhat more negatively than men. Persons who had aphasia for more than 6 months tended to have higher QoL-scores compared with those who had become aphasic more recently. After 8 months, the retested group scored significantly higher on communication and on psychosocial functioning than on first testing.

Conclusions.?Gathering information on QoL after suffering from stroke and from aphasia can lead to a better understanding of the problems involved. The clinical use of instruments such as the SAQoL-39 can probably contribute to a more patient oriented rehabilitation, whereby the focus not only lie in improving linguistic skills but also on reducing the impairments and the handicaps that accompany aphasia and thus on increasing QoL.