Brain, Vol 120, Issue 1 159-182, Copyright © 1997 by Oxford University Press
F Vargha-Khadem, LJ Carr, E Isaacs, E Brett, C Adams and M Mishkin
Case Alex, with Sturge-Weber Syndrome affecting the left hemisphere, failed
to develop speech throughout early boyhood, and his comprehension of single
words and simple commands remained stagnant at an age equivalent of 3-4
years. But then, following left hemidecortication at age 8.5 years and
withdrawal of anticonvulsants when he was more than 9 years old, Alex
suddenly began to acquire speech and language. He also showed an unusual
degree of residual motor capacity on his right side. Alex's remarkable
progress in learning speech and language, and the development of his other
cognitive abilities, were measured periodically from the age of 9 to 15
years. His most recent scores on tests of receptive and expressive language
place him at an age equivalent of 8-10 years. Comparison with the level of
function attained in these domains by nine other left hemispherectomized
patients with early onset of disease and comparable IQ (range, 40-68) but
with early development of speech and language, suggests that, surprisingly,
Alex has suffered no permanent disadvantage from his protracted period of
mutism and severely limited comprehension. Although the findings in Alex,
as in other left- hemispherectomized patients, indicate define limits to
the cognitive and linguistic capacity of the isolated right hemisphere,
Alex's achievements appear to challenge the widely held view that early
childhood is a particularly critical period for acquisition of speech and
language or any of their selective aspects, including phonology, grammar,
prosody and semantics. It is concluded that clearly articulated, well
structured, and appropriate language can be acquired for the first time as
late as age 9 years with the right hemisphere alone.
ARTICLES
Onset of speech after left hemispherectomy in a nine-year-old boy
Cognitive Neuroscience Unit, Institute of Child Health, UK.
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