Thursday, June 23, 2016

Foreign accent syndrome

What if you woke up one day suddenly speaking with a Southern twang or French lilt or British accent? In rare cases this happens to people when a brain injury leads to a rare condition called Foreign Accent Syndrome (FAS).

Lisa Alamia, of Rosenberg, Texas, woke up from jaw surgery in December with an unexpected side effect: a new British accent. She has received nationwide attention for her rare FAS diagnosis.

"I was very shocked,” Alamia told ABC News. “I didn't know how to take it. I was very confused. I said 'Ya'll’ all the time before the accent. Once I got the accent, I started noticing I'd say, 'You all.’"

The syndrome usually develops after neurological damage such as stroke. The syndrome means that a person's speech, specifically it's rhythm and tone, is affected. The sudden change in speech can signal a serious problem, according to medical literature. A change in speech in any way, including an accent change, can be the first sign of a stroke, and needs to be evaluated by a doctor immediately.

There are only about 100 documented cases of FAS, which was first described in 1907. A famous case involved a Norwegian woman shunned in her community when she developed a German accent after a traumatic brain injury during the Nazi occupation of Norway in World War II. A Scottish case published last month in Practical Neurology describes another instance of a woman who, like Alamia, developed FAS after a minor dental procedure, trading her Scottish accent for a German one.

Approximately 86 percent of cases are linked to neurological damage in the speech centers of the brain, from strokes, trauma, or other diseases like multiple sclerosis, according to a study published earlier this year in the journal Frontiers in Human Neuroscience. These patients usually don’t take on a specific accent – for example, they don’t have a true German accent – but the general changes in their prosody, or speech, can be mistaken for a specific foreigner.

A second type of FAS is not associated to any brain changes at all. These cases are often psychological in nature – for example, anxiety, depression, or emotional trauma can change aspects of how the brain interprets information and can cause someone to change their speech patterns, according to the Frontiers in Human Neuroscience journal. This can happen even though there is no physiological trauma to the brain that can be detected. However, this does not mean a patient is "faking it," it just means changes have happened in their brain on a subconscious level.

"It's such a rare condition that neurologists don't believe that this is a real condition," said Dr. Toby Yaltho of Houston Methodist Sugar Land Neurology Associates, who treated Alamia. "The big thing is to know that she's not faking it."

FAS is treated in a variety of ways, from behavioral therapy to speech therapy to anti-anxiety medications, and some patients do recover their natural speech, according to medical literature.     See video there.


  1. Liu HE, Qi P, Liu YL, Liu HX, Li G. Foreign accent syndrome: two case reports and literature review. Eur Rev Med Pharmacol Sci. 2015 Jan;19(1):81-5.

    Foreign accent syndrome is a changed accent syndrome mainly caused by brain injury. This study is to report two cases with foreign accent syndrome and their clinical features. And we also point some lasted articles to understand and discuss this disease in clinical manifestation, imaging, language pathology, pathogenesis, diagnosis and treatment for the sake of further study.

    From the article:

    Though the machine of FAS is still unknown, there are two hypotheses. One is that inhibiting the original neural circuits can cause “trace conditioned reflex” in Pavlov doctrine. In other words, inhibited foreign accent nerve center worked after local accent nerve center disorder. The other is that local accent nerve center is destroyed but foreign accent nerve center is intact. FAS is seen as a language, accent and memory dysfunction syndrome. Formation and integrity of language require an intact motor speech network. After local accent memory loop is damaged, relatively static foreign accent loop continues to be active and contacts with Broca’s centre, rendering FAS1 . Damaged loop can be re-established during rehabilitation so that the accent can be returned to local. This also explains the reason that the patients with undamaged or minor damaged Broca's centre can appear FAS. In our study, two cases were diagnosed with craniocerebral trauma caused speech and accent memory disorders. But there were two FAS cases without psychiatric history and secondary brain injury existing FAS during an early stage of language development. So FAS was reckoned as a developmental motor speech disorder other than a clinical syndrome. Some researchers pointed that FAS was not caused by verbal apraxia but basal ganglia movement language disorder and compensation of other sports cortical language center network.

    Diagnosis of FAS is based primarily on clinical manifestations. Its features include rhythm and sound segments damages, which is similar to normal sound but different in accent before brain damage. FAS is now no specific effective treatment. But multiple methods, such as DWI, PWI and MRI, may help us to understand the recovery, functional location and reorganization further during rehabilitation. With recovery, the accent usually can be returned to the original accent. During treatment of primary disease, it is beneficial for language functional recovery to strengthen the language functional exercise and psychological implications.

  2. “They are always asking me how my mom got that accent,” Kylie Alamia said about her mom, Lisa.

    Despite her accent, Lisa Alamia is 100 percent Texan.

    “People who don’t know me, they’re like, 'Hey, where are you from?'" Lisa Alamia said. “I’m from Rosenberg. They’re like, 'Where is that?' I’m like, 'Right here in Rosenberg.' 'Oh, you’re from here? How do you talk like that?' So that’s where the whole story comes up.”

    Six months ago, jaw surgery to correct an overbite also changed Lisa Alamia’s speech.

    “I thought she was joking with me,” said Kayla Alamia, Lisa Alamia’s oldest daughter. “But then she showed me that the doctor diagnosed her with foreign accent syndrome. Then I was like, 'Oh, Lord.'”...

    “'Mum' is probably the one word I notice right away,” Alamia said. “'Kitten' (is another). They think I’m talking about a baby cat. I’m not. I’m saying, 'I’m just kidding.'”...

    “I didn’t know the reaction I was going to get from people,” Lisa Alamia said. “So I didn’t know if they’re going to judge me. Are they going to think I’m lying or even understand how I’m speaking?”

    Thanks to some ribbing from her family and friends, Lisa Alamia is more open than ever. Though her voice no longer intimidates her children.

    “They’re like now there’s no way you sound ‘hood at all,” Lisa Alamia said. “Even if you tried, you wouldn’t be able to sound that way. My daughter laughs at the way I say 'tamales.' I used to be able to say it like a real Hispanic girl. Now, I cannot.”

  3. Keulen S, Verhoeven J, De Witte E, De Page L, Bastiaanse R, Mariën P. Foreign Accent Syndrome As a Psychogenic Disorder: A Review. Front Hum Neurosci. 2016 Apr 27;10:168.

    In the majority of cases published between 1907 and 2014, FAS is due to a neurogenic etiology. Only a few reports about FAS with an assumed psychogenic origin have been published. The present article discusses the findings of a careful database search on psychogenic FAS. This review may be particularly relevant as it is the first to analyze the salient features of psychogenic FAS cases to date. This article hopes to pave the way for the view that psychogenic FAS is a cognate of neurogenic FAS. It is felt that this variant of FAS may have been underreported, as most of the psychogenic cases have been published after the turn of the century. This review may improve the diagnosis of the syndrome in clinical practice and highlights the importance of recognizing psychogenic FAS as an independent taxonomic entity.

    From the article:

    Analysis of the available literature suggests that psychogenic FAS is quite rare (n = 15/105) (14%). During the past decade FAS has increasingly attracted the attention of the scientific community as 93% of the psychogenic FAS cases (n = 14) were published in a time span of only 12 years (2001–2013). The finding that there are more women with psychogenic FAS than men (67% are women, 33% are men), might be partly explained by the increased predisposition of women to several of the associated psychopathologies. Most mental disorders are also more prevalent among women than men (see also: World Health Organization, 2014). For schizophrenia, prevalence figures are esteemed to be equal, irrespective of gender, though symptoms occur earlier in men (Angermeyer and Kühnz, 1988; Saha et al., 2005; National Institute of Mental Health, 2015). On the other hand, the analysis of the neurogenic population revealed a similar demographic distribution: 68.6% of the authentic (neurogenic) FAS cases were women (n = 59/86). Interestingly, Baker (2003) points out that it should also be taken into account that women are twice as likely to seek medical attention than men. It thus seems that the explanation for this demographic distribution remains speculative.