Palilalia: Difference between revisions
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Although the exact cause of palilalia is unknown, the symptoms suggest changes in the [[basal ganglia]]/[[striatum]], [[thalamus]], or damage to the fibers linking the [[cerebral cortex]] to subcortex structures.<ref name="pmid2746281"/> Damage to the SMA can result in a reduction and slowing down of speech, [[muteness]], or repetitive vocal patterns as seen in palilalia.<ref name = "Alario"> {{cite journal |author=Alario FX, Chainay H, Lehericy S, Cohen L |title=The role of the supplementary motor area (SMA) in word production |journal=Brain Res. |volume=1076 |issue=1 |pages=129–43 |year=2006 |month=March |pmid=16480694 |doi=10.1016/j.brainres.2005.11.104 }}</ref> |
Although the exact cause of palilalia is unknown, the symptoms suggest changes in the [[basal ganglia]]/[[striatum]], [[thalamus]], or damage to the fibers linking the [[cerebral cortex]] to subcortex structures.<ref name="pmid2746281"/> Damage to the SMA can result in a reduction and slowing down of speech, [[muteness]], or repetitive vocal patterns as seen in palilalia.<ref name = "Alario"> {{cite journal |author=Alario FX, Chainay H, Lehericy S, Cohen L |title=The role of the supplementary motor area (SMA) in word production |journal=Brain Res. |volume=1076 |issue=1 |pages=129–43 |year=2006 |month=March |pmid=16480694 |doi=10.1016/j.brainres.2005.11.104 }}</ref> |
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Palilalia also occurs in a variety of neurodegenerative disorders, occurring most commonly in [[Tourette syndrome]], [[Alzheimer's disease]], [[progressive supranuclear palsy |
Palilalia also occurs in a variety of neurodegenerative disorders, occurring most commonly in [[Tourette syndrome]], [[Alzheimer's disease]], and [[progressive supranuclear palsy]].<ref name = "Borsel/> Such degradation often appears the regions described above, but can also occur in the [[substantia nigra]] where decreased dopamine production results in a loss of function.<ref name = "Tetnowski"/> It can also occur in a variety of [[genetic disorders]] including [[Fragile X syndrome]], [[Prader-Willi syndrome]], [[Asperger's syndrome]], and [[autism]].<ref name = "Tetnowski"/> |
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==Diagnosis== |
==Diagnosis== |
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Revision as of 00:58, 30 November 2012
Palilalia (from the Greek πάλιν (pálin) meaning "again" and λαλιά (laliá) meaning "speech" or "to talk")[1] is an acquired [citation needed] [dubious – discuss] speech disorder characterized by the involuntary repetition of syllables, words, or phrases. It has features resembling other complex tics such as echolalia or coprolalia, but unlike other aphasias, palilalia is based upon contextually correct speech.[page needed][2] It was originally described by Alexandre-Achille Souques in a patient with stroke leading to left-side hemiplegia,[3] [page needed] although a condition described as auto-echolalia in 1899 by Édouard Brissaud may have been the same condition.[1]
Classification
Palilalia is considered an aphasia, a disorder of speaking, and is not to be confused with speech disorder as there is no difficulty in the formation of internal speech.[1] Palilalia further disassociates itself from speech disorders like stuttering or cluttering as it tends to only express itself in spontaneous speech, such as answering basic questions, and not in automatic speech like reading or singing.[1]
Palilalia may occur in conditions affecting the pre-frontal cortex or basal ganglia regions, either from physical trauma, neurodegenerative disorders, genetic disorders, or a loss of dopamine in these brain regions.[4] Palilalia may be present in a variety of neurodegenerative disorders, occurring most commonly in Tourette syndrome, Alzheimer's disease, and progressive supranuclear palsy.[4][5] Palilalia is a hyperkinetic disorder of the vocal cords. As basal ganglia function is impaired, commands sent to the vocal cords are unfiltered, resulting in the characteristic repetition of words or syllables.[6][7] [page needed]
Characteristics
Palilalia is defined as the repetition of the speaker's words or phrases, often for a varying number of repeats. Repeated units are generally whole sections of words and are larger than a syllable, with words being repeated the most often, followed by phrases, and then syllables or sounds.[3] [2][page needed] Palilalic repetitions are often spoken with decreasing volume and speed up over time.[8]
A 2007 case study by Van Borsel et al. examined the acoustic features in palilalia.[5] AB, a 60-year-old male was diagnosed with ideopathic Parkinson's disease and had noticed changes in gait, posture, writing, and speech.[5] Observation of his perceptual speech characteristics and Frenchay Dysarthria Assessment results suggested AB suffered from hypokinetic dysarthria with a marked palilalia. It was determined to start speech therapy with passive (metronome) and active (pacing boards) pacing techniques to reduce the number of palilalic repetitions. Unfortunately AB was not able to enunciate despite extensive training.[5]
Analysis of AB's speech therapy showed his repetitions lasted from 1 minute 33 seconds to 2 minutes 28 seconds, ranging from 1 to 32 repetitions on some words, and differed from trial to trial. Pauses were present between each repetition, ranging from 0.1 to 0.7 seconds. Van Borsel et al. concluded that AB's palilalic repetitions followed no pattern: the duration of each repetition train did not decrease over time, the number of repetitions per train did not increase, and the duration of each individual word did not decrease in duration. Such results indicated not all palilalic repetitions show an increasing rate with decreasing volume, and defied the two distinct subtypes of palilalia as suggested by Sterling.[9] Sterling's Type A, sometimes called palilalie spasmodique, is characterized by fast repetitions and decreasing volume, while Sterling's Type B, sometimes called palilalie atonique, is characterized by repetitions at a constant rate with interspersed periods of silence.[10] AB showed neither a systematic increase (Sterling's Type A) or a constant duration (Sterling's Type B) and instead fell between the two.
Palilalia has been theorized to occur in writing and sign language.[5][11] A case study by Tyrone and Moll examined a 79-year-old right-handed deaf man named PSP who showed anomalies in his signing.[11] PSP had learned British sign language (BSL) at the age of seven and had developed left-sided weakness and dysphagia at age 77. PSP showed involuntary movements and repetitions in his signing.[11] Tyrone and Moll reported his movements were palilalic in nature, as entire signs were repeated and the repetitional movements became smaller and smaller in amplitude.[11]
Causes
Although the exact cause of palilalia is unknown, the symptoms suggest changes in the basal ganglia/striatum, thalamus, or damage to the fibers linking the cerebral cortex to subcortex structures.[6] Damage to the SMA can result in a reduction and slowing down of speech, muteness, or repetitive vocal patterns as seen in palilalia.[12]
Palilalia also occurs in a variety of neurodegenerative disorders, occurring most commonly in Tourette syndrome, Alzheimer's disease, and progressive supranuclear palsy.[5] Such degradation often appears the regions described above, but can also occur in the substantia nigra where decreased dopamine production results in a loss of function.[4] It can also occur in a variety of genetic disorders including Fragile X syndrome, Prader-Willi syndrome, Asperger's syndrome, and autism.[4]
Diagnosis
Palilalia must be differentiated from other complex tic disorders (such as echolalia), stuttering,[13] and logoclonia. In contrast to stuttering or logoclonia, palilalic repetitions tend to consist of complete sections of words or phrases,[5] are often repeated many times,[14] and the speaker has no difficulty initiating speech.[1] Unlike echolalia, palilalic repetitions are often [citation needed] [dubious – discuss] the speaker's own words, rather than words spoken by others.
Treatment
Treatment for palilalia may include speech therapy, focusing on slowing down speech rate and emphasizing enunciation.[5] Passive or active pacing techniques can assist in controlling repetitions.[15][5] Such techniques involve a speech therapist, computer, or the person pointing to the first letter of each word before it is spoken. Slowing down speech in this manner can increase intelligibility of conversational speech by 17%.[page needed] [16]
References
- ^ a b c d e Critchley M (1927). "On palilalia". J Neurol Psychopathol. 8 (29): 23–32. doi:10.1136/jnnp.s1-8.29.23. PMC 1068500. PMID 21611242.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ a b [page needed] Maassen B, Kent R, Peters H; et al. Speech motor control: In normal and disordered speech. Oxford University Press. pp. 442–??. ISBN 978-0-19-852627-8.
{{cite book}}: Explicit use of et al. in:|author1=(help)CS1 maint: multiple names: authors list (link) - ^ a b [page needed] Mantie-Kozlowski A (2008). Repetitive verbal behaviors in free conversation with a person with progressive multifocal leukoencephalopathy. ProQuest. ISBN 978-0-549-62729-6.
- ^ a b c d Van Borsel J, Tetnowski JA (2007). "Fluency disorders in genetic syndromes". J Fluency Disord. 32 (4): 279–96. doi:10.1016/j.jfludis.2007.07.002. PMID 17963937.
- ^ a b c d e f g h i Van Borsel J, Bontinck C, Coryn M, Paemeleire F, Vandemaele P (2007). "Acoustic features of palilalia: a case study". Brain Lang. 101 (1): 90–6. doi:10.1016/j.bandl.2006.06.118. PMID 16890278.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ a b Ackermann H, Ziegler W, Oertel WH (1989). "Palilalia as a symptom of levodopa induced hyperkinesia in Parkinson's disease". J. Neurol. Neurosurg. Psychiatr. 52 (6): 805–7. PMC 1032047. PMID 2746281.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ [page needed] Devinsky O, D'Esposito M. (2004). Neurology of Cognitive and Behavioral Disorders: Oxford University Press.
- ^ Benson DF, Ardila A (1996). Aphasia: a clinical perspective. Oxford University Press. p. 291. ISBN 978-0-19-508934-9. Retrieved 19 November 2012.
- ^ Sterling W (1924). "Palilalie et le symptome 'linguosalivaire' dans le Parkinsonisme
encéphalitique". Revue Neurologique (in French). 32: 205–20.
{{cite journal}}: line feed character in|title=at position 65 (help) - ^ Benke T, Butterworth B (2001). "Palilalia and repetitive speech: two case studies". Brain Lang. 78 (1): 62–81. doi:10.1006/brln.2000.2445. PMID 11412016.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ a b c d Tyrone ME, Woll B (2008). "Palilalia in sign language". Neurology. 70 (2): 155–6. doi:10.1212/01.wnl.0000279378.09844.89. PMID 18180445.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ Alario FX, Chainay H, Lehericy S, Cohen L (2006). "The role of the supplementary motor area (SMA) in word production". Brain Res. 1076 (1): 129–43. doi:10.1016/j.brainres.2005.11.104. PMID 16480694.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Lundgren K, Helm-Estabrooks N, Klein R (2010). "Stuttering Following Acquired Brain Damage: A Review of the Literature". J Neurolinguistics. 23 (5): 447–454. doi:10.1016/j.jneuroling.2009.08.008. PMC 2901556. PMID 20628582.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Blanken G, Dittman J, Grimm H, Marshall J, Wallesh C.-W. (Eds.), "Repetitive phenomena in aphasia" in Linguistic disorders and pathologies. An international handbook, Waltger de Gruyter, Berlin/New York (1993), pp. 225–238
- ^ Helm NA (1979). "Management of palilalia with a pacing board". J Speech Hear Disord. 44 (3): 350–3. PMID 480939.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ [page needed] McNeil MR (2009). Clinical management of sensorimotor speech disorders. Thieme. pp. 179–??. ISBN 978-1-58890-514-7.