Foreign Accent Syndrome (SIA) is a motor speech disorder in which the patient develops a language accent that is markedly different from a premorbid dialect. The pathological phenomenon was described at the beginning of the last century by the French neurologist P. Marie. In 1907, he observed a patient who suddenly developed an Alsatian accent after a stroke. To date, there are reports of more than 100 episodes of this syndrome in the world. The disorder is more common in women, the average age for the appearance of a foreign accent is 25-50 years. The overwhelming majority of patients are right-handed.

The available clinical observations make it possible to rank the causes of the foreign accent syndrome depending on their significance. In all cases, the development of SIA is based on neurological or mental disorders. Most likely reasons:

• Head trauma. Traumatic brain injury is the first most common cause of SIA. Disorders of speech motility can be the result of severe concussions and brain contusions , open head injury, neurosurgical interventions. They usually develop against the background of previous loss of consciousness or coma.
• Brain strokes . The emergence of a foreign accent is regarded as an atypical manifestation of CVA. Most often, the condition develops as a result of cerebral lesions of the left hemisphere. The damage zone includes the premotor and motor regions, Broca‘s center, basal ganglia, and cerebellum.
• Brain tumors . They cause speech dysfunction both due to direct pressure on the brain substance and due to the germination of cerebral structures. There is a known case when SIA developed after resection of a giant oligoastrocytoma located in the left insular lobe with the involvement of the frontotemporal region.
• Demyelinating diseases. A typical speech disorder in multiple sclerosis is cerebellar dysarthria , accompanied by chanting speech . However, in some cases, rhinophony , phonetic distortions, dysprosody may appear .
• Mental disorders. SIA is found in the clinic of a number of pathopsychological syndromes: hysterical psychosis, bipolar affective disorder , Asperger’s syndrome, PTSD . An observation is described when an American suffering from schizophrenia , during periods of exacerbation, had a British accent in his speech: the more severe the relapse was, the more pronounced the peculiarities of pronunciation were.

There are isolated reports of cases of foreign accent syndrome associated with severe migraine , arteriovenous malformation of the brain, surgical intervention in the jaw region.

As a result of cerebrovascular, tumor, traumatic, neurodegenerative pathologies, damage to the motor cortical regions, subcortical structures, and the cerebellar region occurs. These departments are responsible for the implementation of various aspects of linguistic activity: articulation, phonology, prosody, etc. The defeat of these areas causes articulatory dyspraxia , the disintegration of the kinetic melody of the word and the rhythmic-melodic structure of speech in general.

At the same time, minimal articulatory disturbances arise, which others regard as a foreign accent. Speech intonation, emotionality, stress, pauses also suffer. The manner of expressive speech changes. Grammatical and semantic components, speech understanding are not impaired.

Some researchers consider foreign accent syndrome to be a mild form of speech apraxia , but patients with SIA have better control over their motor impairments. That is, a foreign accent acts as a way and form of compensation for their speech deficit.

In 2010, neurolinguists P. Marien and D. Verhoeven identified several variants of the foreign accent syndrome. The SIA classification was based on the etiopathogenetic principle:

• neurogenic syndrome – develops as a result of acute or chronic cerebral damage. It is subdivided into acquired and evolutionary types (the emphasis is noticeable from an early age);
• psychogenic syndrome – associated with psychological personality traits or mental disorders;
• mixed syndrome – occurs in neurological diseases, but changes the psychology of the personality, affects the awareness of self-identity.

The speech of a patient with foreign accent syndrome has the correct grammatical design, but differs from the premorbid dialect in phonetic and prosodic features. According to its acoustic characteristics, it is perceived by others as a foreign language, unusual for native speakers. Typical clinical signs of the syndrome are:

• change in the phonation of vowel sounds: stretching or shortening the phonation time, increasing the degree of tension, pharyngalization, monophthongization of diphthongs (merging two vowels into one phoneme);
• another manner of pronunciation of consonants, not typical of the dialect of the native language (for example, uvular vibration of the tongue instead of alveolar); classification
• changes in speech intonation: tempo, rhythm, melody, stress, pause.

Patients with foreign accent syndrome note that they have never been regions in whose dialect they begin to speak, and have not had long-term contacts with local residents.

In the studies, individuals with SIA reported serious psychological problems, difficulties in communicating with others, a sense of loneliness, discrimination on the basis of ethnicity due to an “alien” accent. Some patients develop prolonged depression , mutism. These conditions require psychotherapeutic help. In addition, the appearance of a foreign accent may be a sign of an impending illness of the psyche or the central nervous system, so it should not be ignored.

Since foreign accent syndrome accompanies the clinic of mental or neurological diseases, the examination should be aimed at elucidating the mechanisms and etiology of the primary disorder. To develop an integrated therapeutic approach, it is necessary to carry out pathopsychological and speech therapy diagnostics . Patients with SIA are prescribed:

1. Neurological examination. In order to identify morphological changes (areas of ischemia, hemorrhage, tumors, atrophy), cerebral MRI or CT scanning is performed . The methods of clarifying diagnostics are PET-CT and SPECT of the brain. The functional activity of the central nervous system helps to assess the electroencephalography .
2. Psychiatrist / psychotherapist consultation. Required for the differential diagnosis of neurogenic and psychogenic foreign accent syndrome. Pathopsychological diagnostics, personality structure research are carried out.
3. Speech therapist consultation . Examination of various aspects of oral speech (expressive, receptive, grammar, sound pronunciation, vocabulary) reveals impaired links of speech function. Sometimes Broca‘s aphasia, dysarthria can be hidden behind the syndrome of a foreign accent.
4. Neuro-linguistic diagnostics. For scientific purposes, a study of the language function can be carried out, the exact dialect can be determined based on the analysis of the prosodic and phonetic characteristics of speech. To objectify the data, phonetography and acoustic analysis of the voice using computer programs are used.

Special therapy for SIA has not been developed. Usually, its correction is carried out in the process of treating the underlying pathology: TBI, stroke, cerebral tumors, MS, manic-depressive psychosis, schizophrenia, etc. The following methods are used as part of a comprehensive rehabilitation program:

• Pharmacotherapy . Patients with cerebrovascular pathology are prescribed antihypertensive, anticoagulant, neuroprotective drugs. In the first hours after the development of ischemic stroke, systemic or selective thrombolysis is effective. For the treatment of mental disorders, antipsychotics, normotimics, antidepressants, anxiolytics are used .
• Psychotherapy . Among the methods of psychotherapeutic treatment, cognitive-behavioral therapy and family psychotherapy are used. The priority task is to maintain the social and communicative activity of patients, to accept themselves and their characteristics.
• Logotherapy . The purpose of speech therapy classes is to improve motor speech skills, mastering the correct articulation of sounds, the rhythmic pattern of speech. Articulatory gymnastics , logomassage , vocal therapycan be used as auxiliary methods.