Foreign Accent Syndrome

What is Foreign Accent Syndrome?

A person’s speech pattern unexpectedly and suddenly changes without making a deliberate attempt to do so. As a result, an incredible condition occurs known as foreign accent syndrome. It is rare and real neurological disorder. ⁽⁸⁾

The patient uses the words of native language and choice of words are mainly affected. The intonation and speech output is altered which makes the speaker sound like a foreigner. The complication occurs due to severe injury to the brain. The stories of foreign accent syndrome often sound sensational and have always been the source of media interest. The other names of this syndrome are Pseudo-accent syndrome and Unlearned Foreign Accent Syndrome. Irrespective of gender any individuals of any age may be affected by foreign accent Syndrome.

Symptoms

The features of speech disorders like aphasia and apraxia can be seen in foreign accent syndrome. This is not intentional but a condition that starts from changes.

Consistent predictable errors seen in foreign accent syndrome are as follows:

• Using excessive or equal stress on syllables
• Vowel distortions
• Prolongations or substitutions like ‘yeah’ for ‘yah’
• Consonant distortions, deletion or substitutions
• Consonant cluster pronunciation difficulty
• Inserting ‘uh’ into words
• Voicing mistakes like pike instead of bike
• Moving jaw or tongue differently while speaking
• Inappropriate way of organising sentences
• Yet times knowledge of the native language may disappear totally

Symptoms may last for months, years or may be permanent.

Risk factors

• High risk for stroke
• High blood pressure
• High cholesterol level
• Heart abnormalities
• increased body weight
• Smoking
• Alcoholism
• Migraine
• Apraxia or aphasia⁽⁵⁾

Causes

Most often foreign accent syndrome is caused as a result of brain damage. The other cause may be of traumatic brain injury like a sharp blow to the skull.

• Brain trauma
• Stroke
• Brain hemorrhage
• Brain tumor
• Multiple sclerosis
• Lesions on the brain
• Mental health problem instead of neurological damage
• Injury to the skull
• Bleeding inside the brain⁽⁴⁾

When FAS occurs from a stroke, the damage is most often in the left hemisphere of the brain. It occurs usually in an area of the brain that controls the melody of speech and rhythm. Neurogenic causes like brain haemorrhage and multiple sclerosis are caused by the damage to tissue in the central nervous system. Certain part of the injured brain which affects speech, if released too quickly, damages the brain and destroys the non-foreign accent cells.

FAS – an accent change:

The cases include accent change from British English to American English, Japanese to Korean American English to French, Spanish to Italian, etc. Speech output doesn’t come across as abnormal or pathological; instead they simply seem to be foreign. The patients exhibit their accent without any effort. The mounting evidence is that the cerebellum which controls the motor function crucially involves reinforcing the notion.⁽⁵⁾

Diagnosis

A team of health care specialists

A team of health care specialists should together work in making diagnosis and treating the foreign accent syndrome. The team consists of:

• Neurologist
• Clinical psychologist
• Neuropsychologist
• Language and speech therapist
• Radiologist

The team should make assessment considering the patient’s medical history, education, family history and exposure to foreign languages.

Examination

To arrive at a definite diagnosis the following examinations should be made:

• The physical examination — made out of the patient’s oral structure, particularly the organs used for speech
• Images of the patient’s brain — includes
• An MRI scan—using magnetic waves take pictures inside the brain
• CT scan – imaging test using specialised x-rays
• A single-photon emission computed tomography (SPECT) scan – test that shows the blood flow inside the brain
• Electroencephalogram (EEG)—uses electrical current to record the brain’s activity

Figure 1 Brain MRI showing the plaque: on FLAIR-weighted imaging (at left) and enhancement after gadolinium injection (at right).

Figure 2 A: Diffusion tensor imaging (DTI)-derived tractography (1.5-T MRI scanner; diffusion gradients in 30 noncolinear directions; postprocessing on a SIEMENS Syngo Acquisition Workplace; Regions of interest (ROI) manually drawn in corticospinaltracts at the level of midbrain): lesion (white arrow) near the left corticospinal tract (black arrows); B: Functional magnetic resonance imaging (MRI) (classical T2*-weighted echo planar imaging gradient echo sequence on a 1.5 MRI scanner with a lips movement task, data processed using SPM2 software): lesion (white arrow) close to the motor area for right face (red arrow); C: Brain single photon emission computed tomography (SPECT) (horizontal and 3D (of the right side) reconstruction) showing right prerolandic, temporal, and thalamic diaschisis.

In the process the person’s psychological problems also will be ruled out.^(3),(1),(7)

Complications

Complications associated with Foreign Accent Syndrome include:

• identity crisis
• self-confidence issues
• frustration
• social anxiety
• immense stress

The above complications may result in patients isolation by the community around them.(2)

Treatment

The FAS has no cure since it is most likely the result of a brain injury. However, the condition may be managed by

• Speech therapy—speech therapists and speech pathologists can help the patient to discover new ways to relax certain muscles in the mouth while developing strategies to compensate
• Psychological therapy/ counselling—working with counsellor helps to relieve stress and take steps to regain former patterns of speech
• Medication—doctors believe FAS causes could be related to multiple sclerosis or migraines and some medications may help when combined with psychological and speech therapy
• Assimilation—moving the individual with foreign accent into that foreign country, where they may not feel strange, isolated, or even be persecuted for their strange accent (6)

Prevention

As stroke is the most common cause for FAS, the following preventive measures can be taken:

• Regular exercise
• Healthy diet
• Ideal weight maintenance
• Regular health checkups and medications to control blood pressure
• Drinking alcohol in moderation
• Quit smoking
• Illegal drug abuse
• Keeping chronic conditions under control
• Enough rest to lower stress
• Call for emergency services if you have symptoms of stroke(even if symptoms stop) (8)

Prognosis of FAS

• A disorder that may not be reversible
• Some individuals with the condition have been known to recover their accent

References:

1. Foreign Accent Syndrome Support—University of Texas at Dallas. http://www.utdallas.edu
2. Garst D, Katz W. Foreign accent syndrome. ASHA Leader. 2006;11:10-11,31.. http://msj.sagepub.com/
3. Keulen, S., Verhoeven, J., De Witte, E., De Page, L., Bastiaanse, R., & Mariën, P. (2016). Foreign Accent Syndrome as a psychogenic disorder: a review. Frontiers in human neuroscience, 10.
4. Mariën P., Verhoeven J., Engelborghs, S., Rooker, S., Pickut, B. A., De Deyn, P.P. (2006). A role for the cerebellum in motor speech planning: evidence from foreign accent syndrome. Clinical Neurology and Neurosurgery, 108, 518-522.
5. Miller N. Foreign accent syndrome. Not such a funny turn. Inter J Ther & Rehab. 2007;14:388.
6. National Institute on Deafness and Other Communication Disorders (NIDCD) http://www.nidcd.nih.gov
7. Reeves, R, Burke R, Parker, J. Characteristics of psychotic patients with foreign accent
8. syndrome. J Neuropsychiatry Clin Neurosci. 2007;19(1):70-76.