BOOK REVIEW

By Murray Grossman, MD
Cahana-Amitay D and Albert M (2015)
Redefining Recovery from Aphasia
New York: Oxford University Press
281pages, with preface and index

Language is an incredibly complex process. Yet we speak and under- stand effortlessly in order to live our lives daily. The disruption of language following a stroke is a devastating blow to an individual’s day-to-day functioning because of our extreme dependence on this modality of communication. Aphasia is extraordinarily costly to individuals and to society. Nevertheless, aphasia following a stroke is common.

Despite the high cost and common occurrence of aphasia, progress in developing successful treatments for aphasia has been slow. It has proved difficult to demonstrate that traditional speech and language therapies are better at improving communication skills than friendly social interactions. Thus, novel approaches to treatment and recovery from aphasia are desperately needed.

In this timely book, Cahana-Amitay and Albert outline an alternate approach to recovery from aphasia. Their perspective is based on the view that language is not a modular entity, but instead interacts with multiple facets of non-linguistic cognition. This includes domains such as executive functioning, visual processing, attention, memory, emotion and praxis. In turn, the authors observe that brain regions involved in language are highly interconnected with brain regions subserving these other aspects of cognition. The authors coin the phrase “neural multifunctionality” to characterize this multifaceted clinical and functional neuroanatomic approach to language.

In nine chapters, Cahana-Amitay and Albert lay out their approach to language and recovery from aphasia. The first chapter situates their volume in the context of the extensive literature describing recovery from aphasia. The second chapter outlines the authors’ multifunctionality approach to the functional neuroanatomy of language following stroke. In subsequent chapters, Cahana-Amitay and Albert discuss the relationships between language and each of the other domains of cognitive functioning that interact with language. Each chapter defines a domain of cognition, reviews cognitive aspects of the domain and its interaction with linguistic functioning, and then defines the functional neuroanatomy of the cognitive domain. Treatments for aphasia that focus on each domain of cognition are then reviewed.

In the chapter concerned with executive functioning, for example, the authors consider the ways in which language and executive functioning interact, and review disorders of executive functioning observed in aphasic patients such as perseverations, disorders of discourse, and semantic control impairments. Neural correlates of discourse and executive functions in aphasia are then reviewed. The chapter concerned with attention addresses “basic attention” concerned with vigilance and arousal, and “complex attention” selective and alternating attention. After discussing the relationship between attention and language, Cahana-Amitay and Albert examine the neural underpinnings of attention-language interactions and treatments of attention in language.

The chapter devoted to memory examines the role of working memory and other forms of memory in language processing, and the effects of working memory deficits on language functioning. The authors then consider the contribution of memory systems to aphasia treatments and recovery from aphasia as well as learning and anatomic structures implicated in aphasia therapies. In the chapter examining the role of emotion in recovery from aphasia, Cahana-Amitay and Albert examine altered emotions in aphasia, such as depression and anxiety, and interventions focusing on depression and anxiety. The chapter concerned with praxis assesses the breakdown of gesture in aphasia and the intimate connection between gestural and linguistic forms of communication in theories of apraxia. Finally, the authors consider the role of visual processing in recovery from aphasia, including the effects of visual scenes and audiovisual stimulation in language processing, and the role of visually mediated cueing in recovery from aphasia.

In the final chapter, Cahana-Amitay and Albert marshal evidence from the previous chapters to support their neural multifunctionality hypothesis. They conclude that findings from lesion, neuroimaging and electrophysiological studies support their contention that non-linguistic functions need to be incorporated into language models of the intact brain, and that recovery from aphasia must take into account the role of non-linguistic functioning.

Cahana-Amitay and Albert are experienced aphasiologists at the Harold Goodglass Aphasia Research Center of Boston University and the Boston Veterans Administration Medical Center. The authors provide a comprehensive landscape of language and the brain based on functional neuroanatomic theories that have been evolving over the past two decades. The authoritative voice of these authors compels us to reconsider classic approaches to aphasia, and develop novel forms of speech therapy that are organized around the principle of multifunctionality.

By John D. England, MD

John D. England, MD

The Journal of the Neurological Sciences (JNS) is a broad-based journal that publishes articles from a wide spectrum of disciplines, ranging from basic neuroscience to clinical cases. Because JNS is the official journal of the World Federation of Neurology (WFN), the Editorial Board welcomes submissions from around the world. We also strive to publish papers with unique and original observations. In order to satisfy this latter goal, only the best manuscripts are accepted for publication in JNS.

I frequently receive correspondence asking why manuscripts are rejected. The most frequent reason for rejection is that the manuscript does not receive a high enough priority score when the scientific methodology and conclusions are assessed. In view of these criteria for acceptance, my first advice to authors is to design and perform their scientific studies in as rigorous and as thorough a manner as possible. Additionally, original and novel observations are more likely to attain higher scores by reviewers.

As a last but very important point, authors should write the manuscript as clearly and concisely as possible. The English syntax and grammar should be polished and well-edited. When we receive manuscripts that are poorly written, we always send them directly back to the authors for revision prior to more formal review. We cannot publish manuscripts that are poorly written even if the underlying scientific methodology and observations are sound.

We recognize that English is not the native language of many of our authors, and we will allow re-submission of manuscripts that require editing. My suggestion for authors is to have their manuscripts edited by someone who has excellent command of the English language. If you do not have ready access to such a person, please utilize one of the many excellent “English editing” services. In fact, Elsevier will provide this online service to authors for a modest fee.

In our ongoing attempt to enhance accessibility of JNS articles to members of the WFN, we have selected two more “free-access” articles, which are profiled in this issue of World Neurology.

1) Aaron Berkowitz, et al., provide a well-written and richly referenced review on the neurologic manifestations of neglected tropical diseases (NTDs). They focus the review on 17 diseases that the World Health Organization has designated neglected tropical diseases. These diseases disproportionately affect the world’s poorest populations and cause significant morbidity and mortality. In fact, at least 1 billion people around the world are affected by these diseases. Most of these diseases have significant neurologic manifestations. Importantly, these diseases can be controlled using relatively low-cost but strategic plans.
Berkowitz AL, Raibagkar P, Pritt BS, Mateer FJ. Neurologic manifestations of the neglected tropical diseases. J Neurol Sci. 2015;349:20-32.

2.) Edward Mader, et al., provide an interesting and unique case description of a young woman with biopsy-proven tumefactive multiple sclerosis and acute hepatitis C virus 2a/2c who was successfully treated with interferon beta-1a. Although this report is based upon only one case, the observations are potentially very important. The report raises the possibility that a link exists between hepatitis C infection and multiple sclerosis, and it also suggests that interferon beta-1a may be effective treatment for some patients with hepatitis C infection. One particularly reasonable suggestion is that patients with acute CNS demyelination be screened for hepatitis.
Mader EC, Richeh W, Ochoa JM, Sullivan LL, Gutierrez AN, Lovera JF. Tumefactive multiple sclerosis and hepatitis C virus 2a/2c infection: Dual benefit of long-term interferon beta-1a therapy? J Neurol Sci. 2015;349:239-242.