Foreign accent syndrome in Multiple Sclerosis, review and case presentation.

Abstract

Introduction. Foreign Accent Syndrome (FAS) is a rare entity. Patients develop changes in rhythm and tone of speech (prosody), perceived as a different accent than their native language. There are three types of FAS: neurogenic, psychogenic and mixed. FAS is rare in MS, and even more so as a debut symptom.

Objective. Review of FAS, types, pathophysiology, presentation in MS and evolution.

Summary. Cortical lesions in MS are correlated with cognitive impairment, motor disability, psychiatric symptoms, language disorders, speech impairment, and seizures. Aphasia is a rare symptom in MS (0.7 - 3%). Most of the published cases of FAS have suffered injury in the dominant hemisphere, in the prerrolandic cortex and adjacent areas, frontal motor association areas, in the putamen, basal ganglia, and the posterior fossa (protuberance, cerebellum). Different etiologies have been reported, vascular being the most frequent. We present the case of a 44-year-old woman who debuted with FAS, previously interpreted as a brain ischemia and finally diagnosis as multiple sclerosis.

This case had partial improvement of the symptoms after phonoaudiologic rehabilitation.

Conclusions. FAS is a rare form of MS debut, as cortical symptoms are atypical relapses. Demyelinating etiology should be considered in young patients with few or without vascular risk factors, and must be supported by complementary neuroimaging studies.