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“Aphasia without aphasia”: A case series exploration of the role of the left pre-supplementary motor area in self-generated speech

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Poster B52 in Poster Session B, Tuesday, October 24, 3:30 - 5:15 pm CEST, Espace Vieux-Port

Deborah Levy1, Edward Chang1; 1University of California San Francisco

In 1968, Luria & Tzvetkova described, in their words, “a kind of ‘aphasia without aphasia’”—a syndrome in which motor speech, naming, repetition, and comprehension were all preserved, and yet the ability to produce self-generated connected speech was markedly disturbed. Such paradoxical language presentations are somewhat rare, but have been reported and theorized at various points throughout the history of aphasiology, primarily in stroke populations. However, investigations of stroke are limited by stereotyped patterns of vascular damage as well as limited availability of pre-injury baseline data. Thus, investigation of this language profile in other clinical cohorts is warranted. Here we present a series of seven cases involving surgical resection of left medial frontal regions, predominantly centered on the left pre-supplementary motor area (pre-SMA) and its underlying cortical white matter, demonstrating marked and disproportionate deficits when responding to open-ended questions (e.g. “Tell me about your family”) as compared to constrained speech production tasks (e.g. repetition, confrontation naming, and reading aloud). Connected speech was characterized by severe anomia, perseverations, frequent word finding pauses, and decreased length of utterance. Neither motor speech nor motivational deficits were observed. Only one of these patients displayed measurable deficits in speech production (connected or constrained) prior to surgery. The majority of patients demonstrated recovery of language within normal limits within one month; two, however, demonstrated persistent impairments. This observed constellation of symptoms is similar to but distinct from well-known SMA syndrome, characterized by transient mutism and hemiparesis following resection in the left supplementary motor area. We present these findings (a) in an effort to further integrate the neurosurgical literature into current theories of the language network, (b) to discuss similarities and differences with previously theorized subtypes of aphasia and adynamia, and (c) to highlight the potential role of a region generally excluded from classical models of the language network, the pre-SMA, in the self-generation of connected speech.

Topic Areas: Disorders: Acquired, Language Production

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