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Understanding foreign accent syndrome
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  • Published on:
    Authors' response to 'An overestimation?'
    • Laura McWhirter, Neuropsychiatrist University of Edinburgh and NHS Lothian
    • Other Contributors:
      • Jon Stone, Professor of Neurology
      • Nick Miller, Professor Emeritus of Speech Pathology
      • Alan Carson, Professor of Neuropsychiatry

    We, the authors, thank Berthier for his comments on our study of 49 individuals with self-reported Foreign Accent Syndrome.

    In response, we would first like to clarify that we do not use Berthier’s term ‘psychogenic’, but ‘functional’ in our paper, referring to foreign accent symptoms due to changes in neural function rather than (or in addition to) the direct effects of a structural lesion. The body-mind dualism implied by the terms ‘psychological/psychogenic’ vs ‘neurogenic’ no longer holds water. Berthier himself notes that the differentiation between “functional” and “structural” may be artificial and that there has been great progress in “unveiling of the neural basis” of functional disorders. As we frequently emphasise in explaining the diagnosis to individuals with functional neurological disorders, their symptoms are definitely ‘real’; not ‘imagined’; and have a basis in changes in neural function which we are beginning to understand more clearly [1,2].

    We accept the limitations provided by our method of data collection, including limited data about investigations and a likelihood of selection bias where those with predominantly functional FAS may be somewhat over-represented in our sample. We wish to clarify, however, that cases were classified as ‘probably functional’ on the basis of reported positive clinical features of a functional disorder (e.g. periods of return to normal accent, adoption of stereotypical behaviours) and not by the presence...

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    Conflict of Interest:
    None declared.
  • Published on:
    An overestimation of diagnosing functional foreign accent syndrome?
    • Marcelo L. Berthier, Professor of Neurology. University of Malaga Unit of Cognitive Neurology and Aphasia Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga,Malaga, Spain
    • Other Contributors:
      • Ignacio Moreno-Torres, Professor of Linguistics

    Elucidating the nature of the foreign accent syndrome (FAS) can contribute to improve its diagnosis and treatment approaches. To understand this apparently rare syndrome, McWhirter et al. 1 studied a large case series of 49 subjects self-reporting having FAS. The participants were recruited via unmoderated online FAS support groups and surveys shared with neurologists and speech-language therapists from several countries. Participants completed an online protocol including validated scales tapping somatic symptoms, anxiety and depression, social-occupational function, and illness perception. They were also requested to provide speech samples recorded via computers or smartphones during oral reading and picture description. The overall clinical presentation of FAS in each participant was classified by consensus reached by three authors (2 neuropsychiatrists and 1 neurologist) in (1) “probably functional”, (2) “possibly structural” or (3) “probably structural”, wherein (1) meant no evidence of a neurological event or injury suggestive of a functional disorder but with no spontaneous remission; (2) alluded to the presence of some features suggestive of a functional disorder but with some uncertainty about a possible structural basis; and (3) denoted the evidence of a neurological event or injury coincident with the onset of FAS. The recorded speech samples were examined by experts to diagnose FAS and their frequent associated speech-language deficits (apraxia of speech, dysar...

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    Conflict of Interest:
    None declared.