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Perisilvyana syndrome may be associated with changes in hearing

According to studies of Unicamp, language disorders, reading and writing may also be risk factors

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Foto: Divulgação Unicamp
Dr. Mirela Boscariol with patient at the Clinic of Neurology Infanti
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Dr. Mirela Boscariol with patient at the Clinic of Neurology Infanti

When checking changes in language, reading and writing of the patient, the specialist area of ​​diagnostic imaging may have evidence that is before any damage to the nervous system, neuroanatomical substrate, or also some genetic component. The polymicrogyria is a malformation that a typical case is beyond the normal anatomical pattern, characterized by many microgiros around the sylvian fissure, responsible for encoding and articulatory motor programming language spoken. This syndrome is present in polymicrogyria perisilvyana and due to its proximity to auditory regions essential for language development, suggests that auditory processing may be altered in this syndrome. This means that these changes should also be considered as a risk factor for language impairment, reading and writing, and auditory processing. This is one of the main conclusions of the doctoral thesis of Mirela Boscariol, defended at the Faculty of Medical Sciences (FCM).

This work included the design theme Perisylvian Syndrome, coordinated by Professor Marilisa Mantovani Guerreiro, which is the thesis advisor and head of the Clinic of Child Neurology located on the second floor of the Hospital de Clinicas (HC) at UNICAMP. The FAPESP thematic project, recently completed, included four subprojects, and the Mirela Boscariol belonging to the axis of language.

The work of the therapist discussed the evaluation of auditory processing, language, reading and writing of 33 students aged 8 to 16 years. Among the universe of 33 evaluated, 12 students presented the lesion and language disorders, reading and writing, and auditory processing, ten children had only the disturbances, but had no injuries, and 11 showed no change and no injury. These students were accompanied by the Department of Neurology at HC between 2007 and 2009. The research was extended to the pathologist, so that what was initially to be a research progressed so that now constitute a doctoral dissertation.

The assessments were made in speech pathology graduate student by itself, and included assessment of language, as was to investigate the speech of students, understanding, to identify the knowledge level of students to take ownership of information, reading and writing, and auditory processing. In addition, she received the opinion of other experts. The school underwent neurological assessment with the teacher Marilisa Guerreiro, for evaluation of magnetic resonance imaging was examined by a neurologist at the FCM Fernando Cendes, and neuropsychological assessment psychologist Catherine Guimaraes.



Perisylvian syndrome is identified by polymicrogyria in the brain, the region of the sylvian fissure. Around this fissure, in people with this syndrome, it is seen as a malformation in cortical development characterized by an excessive number of small rounds, giving the cortical surface appear jagged and rough. The severity of clinical symptoms can be correlated with cortical involvement. There are multiple microgiros not appear in well-formed brains, reports Mirela Boscariol.

According to the researcher, the sylvian fissure includes auditory regions essential as the auditory cortex, that much is related to language development. So if there is a change in language and auditory information processing, it may be due to change in the sylvian region, notes.

This syndrome is rare and may manifest with signs and symptoms vary. Encompasses disorders affecting speech and pseudobulbar signs, characterized by difficulty swallowing and blowing. There is a large spectrum of clinical manifestations ranging from mild to severe cases with cognitive impairment and epilepsy. However, in some cases, the syndrome goes unnoticed until, says the researcher. It's missing a lot of information about the syndrome of often no technology that can identify it.

For the researcher, it is important to clarify that the fact that there is a specific language impairment or learning disabilities does not mean there polymicrogyria. These reports in general, he says, pointing realize that their occurrence is precisely the period of cortical development, while the fetus is developing.

When we started talking about this syndrome, the first descriptions generally alluded to epilepsy. But this concept is not unfounded was a mistake. Is that preliminary studies on the perisylvian syndrome were performed in centers for epilepsy. With advancing years, research has been deepening and clarifying that epilepsy is not always present in the syndrome.

Foix, Chavany and Marie were the first to report the syndrome in 1926. Then came other studies. At Unicamp, the neurologist Marilisa Guerreiro, which conducts research into epilepsy and malformations of cortical development, remained in Canada to study more slowly perisylvian syndrome. His stay in the country, helped in the investigation of significant cases involving epilepsy, cognitive impairment and speech disorders. His return to Brazil originated the themed design of an interdisciplinary nature, which, as Mirela Boscariol contributed to better understanding of the syndrome.

Auditory Processing

The differential of the research was to investigate pathologist auditory processing in children with language impairment and learning - in the presence and absence of cortical injury - and compared with children without any changes. Furthermore, the importance of the study due to the fact that the findings of this study open new perspective for discovering the physical basis of conditions such as dyslexia, for example, impairment of ability to read and write.

Auditory processing refers to the phenomena of localization and lateralization of sound discrimination and auditory pattern recognition and temporal aspects of hearing, with competing acoustic signals and signs of degradation. There is suspicion of auditory processing disorder in the child who asks to repeat what he said is often slow to respond when asked, has difficulty hearing in noisy environments, increasing the volume of the TV shows in the trade talks, even with peripheral hearing normal, describes Mirela Boscariol.

In this study, we concluded that the cortex may have Polymicrogyric atypical functioning and lead to language disorders, delayed speech, exchange letters and, later, an exchange in writing, reading or even the processing of auditory information. What can not be said, according to her, is that all children who are in trade talks have injury.

Other findings

Another aspect observed by the researcher's thesis was that the difficulties in processing can lead to learning difficulties. Moreover, children who have language impairment, reading, writing, auditory processing, and injury, obviously have a worse performance than children who do not.

An action that transcended the proposal of the researcher in the study was the rehabilitation of some children, as it permeates the area of ​​speech automatically. For the researcher, the rehabilitation of language difficulties, learning and auditory processing is possible, he emphasizes, but evolution depends upon the changes made by the child. Another thing: We should pay more attention to language disorders, reading and writing to understand the issue of diagnosis and prognosis - if there is a neuroanatomical substrate or not, this may allow a better treatment planning, guarantees.

The researcher, who holds a degree in Speech Pathology, USP, Bauru, emphasizes that the results obtained here and in the thematic project should contribute to a more accurate diagnosis of the syndrome. Not long ago, saw only scattered studies on it. Now it can be better advice to families, especially parents, she says.


   Palavras-chave:   Perisylvian Syndrome    Language    Reading    Writing    Unicamp      
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