Commentry - (2024) Volume 0, Issue 0
Received: 13-Mar-2024, Manuscript No. IPJNN-24-14657; Editor assigned: 15-Mar-2024, Pre QC No. IPJNN-24-14657 (PQ); Reviewed: 29-Mar-2024, QC No. IPJNN-24-14657; Revised: 05-Apr-2024, Manuscript No. IPJNN-24-14657 (R); Published: 12-Apr-2024, DOI: 10.4172/2171-6625.15.S9.003
In this study authors stated, after available literature, that, if a left perisylvian lesion occurs in 3-4 years age group or younger patients, language recovers favorably, because the great neural plasticity in infants and young preschoolers is higher. On the other hand, the compensation and recovery processes in older children and adolescents are much more limited, although better when compared to adults.
A study was done by Gárriz-Luis, Narbona, Sánchez-Carpintero et al., in which 3 adolescent individuals (two males and one female) are being under careful longitudinal examination. Observation was followed for 5 years and outcomes are being reported since the acquisition of a left perisylvian hemispheric lesion at the ages of 9, 15, 15 years up to 14, 20 and 20 years, respectively. From this observation, the causes of perisylvian lesion observed are noted as follows: Herpetic encephalitis, embolic infarction and infarction due to idiopathic arteriopathy.
The non-verbal IQ was normal-average in all three subjects. The three subjects were administered, longitudinally: A battery of language and cognitive performance, morphological brain Magnetic Resonance Imaging (MRI), repeated dichotic listening test and, in the 5th year, a functional brain MRI (fMRI) with linguistic tasks was performed.
Six months after the brain injury, the patients presented with the following syndromes: Amnestic aphasia, Broca-type aphasia and massive transcortical aphasia. Under speech therapy intervention, the patients improved. Verbal oral comprehension normalized, but oral expressive deficits and reading-writing severe difficulties persisted in all three. According to the dichotic listening test, the initial improvement in oral language corresponded with a dominant use of the right hemisphere and, later, with the activation of peri-lesional structures preserved in the left hemisphere. The hemispheric dominance index, initially right, subsequently changed towards neutral values in two patients; in the patient who recovered her verbal expression less, the dominance index remained absolutely in the right hemisphere.
During the 5th year of follow-up, the brain changes were well defined by functional Magnetic Resonance Imaging (fMRI) with linguistic tasks. Among the three, two patients had moderate clinical recovery, moderate perisylvian activation of the right hemisphere and pronounced activation of the left dorsal extrasylvian left cortex. In the patient with less recovery of verbal expression, the fMRI activation corresponds massively to the right hemisphere, but the left hemisphere, which is extensively damaged, is barely activated.
The findings in this small study are especially valuable due to the prolonged follow-up with neuropsychological evaluations, repeated dichotic listening tests and, finally, fMRI with verbal tasks. The data we provide are consistent with those of other few publications on aphasic adolescents, which use fMRI (12 cases in the literature). The dichotic listening test is rarely used in aphasic adolescents; but, according to our experience, it allows flexible and economical follow-up, to be completed with fMRI.
Recovery processes in adolescents are halfway between those that occur in young preschoolers and those observed in adults. After early childhood, the vicariant power of the right perisylvian structures for language is poor. Patients who subsequently improve more do so thanks to the late activation of dorsal perilesional areas of the left hemisphere. Hence we conclude that this study shows that the innate hemispheric dorsal extrasylvian region plays an important role in functional asymmetry for recovery of language, in favor of the left hemisphere.
Citation: Narbona J (2024) Long Term Recovery Processes Involved in Three Adolescents with Acquired Left Perisylvian Lesion and their Outcomes. J Neurol Neurosci Vol. 15 No.S9:003.
