ABSTRACT
The objective of this paper was to describe the evolution of language assessments in patients with acquired neurological diseases over a period of around 45 years from 1970, when interdisciplinarity in Neuropsychology first began in Brazil, to the present day. The first twenty years of data was based on memories of Speech Pathology University Professors who were in charge of teaching aphasia. We then show the contributions of Linguistics, Cognitive Psychology, as well as Psycholinguistic and Psychometric criteria, to language evaluation. Finally, the current panorama of adaptations and creations of validated and standardized instruments is given, based on a search of the databases Pubmed, Scopus and Lilacs. Our closing remarks highlight the diversity in evaluation approaches and the recent tendency of language evaluations linked to new technologies such as brain imaging and computational analysis.
O objetivo deste artigo é descrever a evolução das avaliações de linguagem em pacientes com distúrbios neurológicos adquiridos durante um período de aproximadamente 45 anos, dos anos 1970 até os dias atuais, quando a interdisciplinaridade iniciou-se no Brasil na Neuropsicologia. Os relatos dos primeiros 20 anos foram baseados em memórias de professores de universidades que possuíam o curso de Fonoaudiologia e ministravam disciplinas de afasia. Após, procuramos mostrar as contribuições da Linguística, da Psicologia Cognitiva para a avaliação da linguagem, assim como dos critérios psicolinguísticos e psicométricos. Por fim, apresentamos o panorama atual das adaptações e criações de instrumentos validados e estandardizados a partir de busca nas bases Pubmed, Scopus e Lilacs. Nossos comentários finais salientam a diversidade dos métodos de avaliação e a tendência recente da avaliação da linguagem estar relacionada às novas tecnologias de imagem cerebral e a análises computacionais.
Subject(s)
Humans , Aphasia , Speech-Language Pathology , Disability Evaluation , Nervous System DiseasesABSTRACT
Introducción. El síndrome de Landau-Kleffner se caracteriza por afasia adquirida y anormalidades electroencefalográficas durante la vigilia y el sueño. El tratamiento con anticonvulsivos controla las crisis convulsivas pero en los problemas de lenguaje y comportamiento su eficacia es menor. Algunos reportes señalan mejoría de lenguaje con el uso de corticoesteroides en etapas tempranas y a dosis altas. Otra opción terapéutica es el uso de calcioantagonistas. Caso clínico. Paciente de 5 años de edad con evolución normal hasta los 2 años hasta que los padres observaron la pérdida espontánea del lenguaje previamente adquirido. En la evaluación neurológica se encontraron abundantes ecolalias e indiferencia a estímulos externos. El electroencefalograma mostró brotes intermitentes de ondas agudas y complejos punta-onda lenta de 3-4 Hz generalizados durante el sueño. Se inició tratamiento con prednisona por un mes y ácido valproico. Se continuó con el ácido valproico y después de 4 meses se añadió flunarizina, con lo que se observó mejoría en el lenguaje. Conclusiones. Este caso presenta los hallazgos clínicos y electroencefalográficos del síndrome; se observó que la mejor respuesta al tratamiento se obtuvo al agregar flunarizina. Esta evidencia contribuye a apoyar su uso y fundamenta la realización posterior de estudios controlados para concluir certeramente sobre su utilidad en el padecimiento.
Background. Landau-Kleffner syndrome is characterized by acquired aphasia and electroencephalographic abnormalities during wake-fulness and sleep. These abnormalities can be solved with anticonvulsive medications, but speech and behavioral problems cannot be treated using this therapy. Instead, there are reports that indicate that treatment with high-dose corticosteroids during early stages of the disease improves the speech difficulties. Use of calcium antagonists has also been proposed as possible treatment. Case report. We report the case of a 5-year-old patient with normal development until the age of 2 years. At that time, the parents observed loss of spontaneous acquired speech. During neurological evaluation, the child showed abundant echolalia and indifference to external stimuli. Electroencephalogram showed sharp waves and generalized slow spike-wave complexes of 3-4 Hz during sleep. We began treatment with prednisone and valproic acid for 1 month; flunarizine was added. After 4 months of treatment, the patient showed speech improvement. Conclusions. Our case has the characteristic clinical and electroencephalographic findings of Landau-Kleffner syndrome. We observed significant symptom improvement when flunarizine was added to the treatment. This evidence offers support for the use of a calcium antagonist as possible therapy, which may help setting the way for future controlled studies in order to finally establish its utility with this illness.
ABSTRACT
Acquired epileptic aphasia is an age-related epilepsy syndrome. It is an epileptic encephalopathy. The etiology and pathogenesis is unclear. There are many progresses in pathogens, such as of susceptibility genes, the mechanism of autoimmunity, and the disorders of metabolism in brain and so on. But each theory can only explain a part of clinic symptom. In the progress of treatments, more recent case series show that sulthiame and levetiracetam can be considered as effective drugs. There are also progresses in corticosteroid,intravenous immunoglobulims and surgery treatment. Other new methods, such as diet and sign language, are applied in clinical therapy.