the official magazine of the brain injury association of california


Traumatic brain injury can induce
this rare and mysterious syndrome.

Foreign accent syndrome (FAS) is a speech disorder that causes a sudden change to speech so that a native speaker is perceived to speak with a “foreign” accent. FAS is most often caused by damage to the brain caused by a stroke or traumatic brain injury. Other causes have also been reported including multiple sclerosis and conversion disorder and in some cases, no clear cause has been identified Norwegian neurologist Georg Herman Monrad-Krohn reported the best-known case of FAS, in which speech was altered in terms of timing, intonation, and tongue placement causing the subject to sound foreign. In FAS, speech remains highly intelligible and does not necessarily sound disordered. FAS has been documented in cases around the world, including accent changes from Japanese to Korean, British English to French, American English to British English, and Spanish to Hungarian.

There have been only about 100 known cases of the syndrome since it was first eported in the 1940s. The most famous case was a Norwegian woman who was hit by shrapnel in World War II; she developed a German accent and was ostracized as a result. Other cases include a British woman from Devon who developed a Chinese accent following a migraine, and another British woman who had a stroke after which she acquired a French accent. FAS affects only a small a ea of speech — the pattern and intonation — and in some recorded cases appears to have been brought on by a stroke or traumatic brain injury (TBI). The primary symptom of foreign accent syndrome is speaking in an accent associated with a country where the person has never lived or in a language, they have never spoken. For example, a native English speaker who has never left the United States may begin speaking English with a

Spanish accent. Most people with foreign accent syndrome also show symptoms of a psychological or neurological condition. They might have schizophrenia or depression, a recent brain injury, or a medical condition, such as MS or dementia, that damages the brain. A person whose foreign accent changes slightly or who develops a new accent after living abroad would not be considered to have foreign accent syndrome. A person with foreign accent syndrome may seek treatment because they or someone they know noticed the change in their speech. In some cases, however, foreign accent syndrome presents secondary to another symptom. In this scenario, a person seeking emergency psychiatric care might also have an unusual accent, or a head injury survivor may develop a new speech pattern. No specific test can assess for fo eign accent syndrome. Instead, doctors work to diagnose the cause using a variety of tests, including blood tests to test for infections and some illnesses, brain scans, such as MRI scans, to look for lesions or damage in the brain, a lumbar puncture, to test for infections in the spinal flui and to check for signs of certain central nervous system conditions, a complete medical history, to determine when the symptoms

appeared and what may have caused them, and psychiatric screenings, such as assessments for depression and schizophrenia. If a doctor cannot find a physiological cause, they will usuall diagnose a person with psychogenic foreign accent syndrome and work to identify a possible psychological cause. Foreign accent syndrome itself is not dangerous. However, it may warn of a serious medical condition, such as a tumor or lesion in the brain, dementia, or MS. In these cases, treatment will focus on addressing the cause of the foreign accent syndrome. A doctor might prescribe medication for conditions such as MS or surgery for certain brain growths. When there is a psychiatric cause, a doctor may recommend therapy, medication, or both. Many causes of foreign accent syndrome are not curable, though medication can help manage symptoms. In most cases, a doctor will recommend speech therapy to help a person regain their normal habits. When the cause of foreign accent syndrome is unclear — such as in the case of the woman who developed it following dental surgery — speech therapy may be the only treatment option