In the late 1800’s, neurologists Broca and Wernicke discovered lesions (or damage) to the left side of the brain that could possibly destruct speech patterns. Today this is known as Foreign Accent Syndrome or (FAS). FAS is a neurological disorder that causes a person’s speech to be gradually or suddenly accented. It affects both Broca’s area and Wernicke’s area in the brain. The underlying effects of FAS are often led by traumatic brain injuries, hemiplegic migraines, strokes, and/or multiple lesions to the brain (Garst & Katz, 2006).
The left hemisphere of our brain is generally associated with areas that process speech, language, logic, and facts. The right hemisphere is usually affiliated with our surroundings, such as spatial recognition, art, music, and understanding tone. Broca’s area, located in the left frontal lobe, is responsible for forming our words while Wernicke’s area, located near the left temporal lobe, puts those words into sentences (NIH, 2008). Neurologists find that these parts of the brain have something to do with speech production and thus resulting in the patient sounding foreign. This result can cause placement of tongue, pronunciation issues, and slurring of words when speaking (UTD, 2015). Now that you have an understanding of FAS and of the brain, let’s move on to how a patient can take this info and their symptoms to the doctor.
Proper diagnosis comes first for a FAS patient. A patient who may experience slurring of words, frequent headaches, stroke-like symptoms, or memory loss, must seek medical attention immediately. Although with the rarity of FAS, these symptoms can present themselves at any time to any healthy person. A treatment plan for FAS doesn’t end with the first doctor’s visit. A patient with this syndrome will visit a radiologist, neurologist, speech therapist, and a neuropsychologist for months, if not years to improve their situation (Garst & Katz, 2006). A patient will undergo multiple CT scans and MRI’s, but what is most important is the fMRI (functional MRI). The fMRI measures activity in the brain by measuring its blood flow whereas the MRI only shows contrasting tissue images of the brain (UCSD, 2015). In order for doctors, scientists, and researchers to understand this syndrome further, fMRI’s should be the basis of all brain scans for these patients. Since this syndrome is so rare, many doctors and researchers want to and should learn more about how FAS affects the brain and speech. A very popular case study of FAS occurred in 1941 during a German air-raid when a Norwegian woman was injured on the left side of the brain by scrap metal. She experienced speech loss and improved language abilities within the year after the incident. During this time, doctors diagnosed her with FAS (Garst & Katz, 2006). On the other hand, patients who suffer from Aphasia (meaning without speech) can experience speech loss due to the lesions or neural damage on or near Wernicke’s area. FAS patients tend to also mispronounce or delete certain vowels or consonants while speaking (Garst & Katz, 2006). Even though these areas are in different locations of the brain, they are both involved in key aspects of processing speech.
Ellen Spencer, from Indiana, is one of the rare documented cases that currently lives with FAS. She did not suffer from a stroke, but a severe headache. Even though her speech is heavily accented, her singing sounds much like her original voice. In her video, listed below, she sings “Amazing Grace” and her foreign accent is nowhere to be found. Why is this you ask? The right side of the brain is responsible for music and singing information, therefore she is able to use the singing area of her brain to alleviate the foreign accent. I had the opportunity to talk with Ellen via email and her side of the syndrome is very thought-provoking. She says, “The psychosocial aspects can be devastating. Since it’s so rare, getting validation or proper diagnosis is often first a failure and a challenge.” Ellen has also become an advocate for FAS worldwide and even has contributed to a book on the topic titled Foreign Accent Syndromes: The stories people have to tell that is published by Psychology Press to be used in many universities and hospitals. The book, linked below, is written by Jack Ryalls and Nick Miller.
After a few email tags with Ellen and finding out more information on FAS, I do hope that more research will be conducted on this syndrome because there is not much known about it right now and many patients are being misdiagnosed. Even though it is rare, with approximately 100 documented cases, the underlying events that lead to FAS happen all too often (Youtube, 2015). As headaches, head injuries, and strokes occur worldwide every day, conducting research on this syndrome can possibly lead to a proper diagnosis in future patients. This is essential to prevent further harm, and finding out what exactly is causing each specific case and if there is possibly a cure for those living with FAS.
Here’s a link to the Ryalls & Miller FAS book that Ellen Spencer contributed to:
http://www.amazon.com/Foreign-Accent-Syndromes-stories-people/dp/1848721536
Video of Ellen Spencer:
Video of Ellen Spencer on Outrageous Acts of Science (start at 23:00 minutes):
References
Garst, D., Katz, W. (2006). Foreign Accent Syndrome. The ASHA Leader, 11.10, 10-31. Retrieved on June 20, 2015 from http://leader.pubs.asha.org/article.aspx?articleid=2278208
Miller Ph.D., Dave, Thompson Ph.D., Bert, Harrub Ph.D., Brad. The Origin of Language and Communication. Apologetics Press. Retrieved on June 21, 2015 from http://www.apologeticspress.org/image/rr/2002/r&r0208a.jpg
(2008, October). Aphasia. National Institute on Deafness and Other Communication Disorders (NIDCD). Retrieved on June 21, 2015 from http://www.nidcd.nih.gov/health/voice/pages/aphasia.aspx#causes
About FAS/Speech Samples. (2015). Foreign Accent Syndrome (FAS) Support. Retrieved on June 21, 2015 from http://www.utdallas.edu/research/FAS/about/
What is fMRI? (2015). Center for Functional MRI in the Department of Radiology. Retrieved on June 22, 2015 from UC San Diego School of Medicine http://fmri.ucsd.edu/Research/whatisfmri.html
Spencer, E. (2013, May 11). “Foreign Accent Syndrome-Ellen5e learning and teaching Ellens-FAS_Birthday_4.” [Youtube]. Retrieved on June 20, 2015 from https://youtu.be/tfKj82vYm_Y
Outrageous Acts of Science Season 3. (2015, February 25). “Outrageous Acts of Science Season 3 Episode 6 ‘Tested on Humans.’” [Youtube]. Retrieved on June 23, 2015 from https://youtu.be/SMVlUey6Mc0?t=23m
Miss Victoria 
can i now its treatment?
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FAS is a fascinating topic at the same time scary to think you can have a migraine and wake to a different accent. Since FAS is very rare more researcher is needed to understand and try to find a cure. When looking FAS for more information I found that some people may suffer for shorter duration of time than others. Since FAS is not caused by lesions I wonder why some people may suffer for longer than others. I believe in the further we will hear more about FAS.
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Your blog was actually the first one I clicked on this week. Foreign accent syndrome is not something I have heard of before but it piqued my interest right away. Speech complications following a stroke are very common, but those usually include slurred, slowed, or loss of ability to speak. Completely changing a person’s accent that they have had and others have been accustomed to hearing all their life is especially strange. It is hard to believe that damage to areas as small as the Broca and Wernicke can be the culprit of all this. I would have to agree with your response to Chels that Ellen’s accent was more comparable to the speech patterns of a deaf person than any specific region. It is particularly interesting that if she engages the right side of her brain by imagining herself singing, she can speak in her normal voice. In the beginning, I also questioned the integrity of the syndrome and if she may have just been faking, but if a qualified speech professional could not detect deception then who am I to judge. You clearly did your homework by reaching out to Ellen on your own. Kudos on a great blog!
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I found another person with FAS; Kathy Locket. She too had headaches but no stroke before her speech changed. It was interesting to read how the syndrome affected her. She felt as though she was having an identity crisis. With a new accent people did not believe Kathy lived in their town and this made Kathy feel out of place. You can read more about Kathy below.
http://www.dailymail.co.uk/health/article-2778297/The-woman-Foreign-Accent-Syndrome-Mother-goes-bed-broad-Staffordshire-accent-wakes-sounding-POLISH.html
What I would be very curious to see is a brain scan of Kathy’s head prior to her head aches and a brain scan when she had them to see the progression of this syndrome. It seems like the change in accent did not come on suddenly and when it did, it was a slow progression. To me , this indicated that something in her brain is changing, not necessarily dying. My guess would be that the brain is damaged but on the road to recovery, new neural connections are made resulting in a new accent. Another way of thinking about it is that different accents are made with slightly different neural connections. It’s not like a new york accent is normal and an accent from Tennessee is caused by brain damage. Therefore, I do not believe that the accent change of people with FAS is caused by brain damage but a rewiring of neural connections perhaps while the brain heals.
I found a study that discusses pathogenesis of FAS and it brought up that there have been FAS cases without psychiatric history and brain trauma but in early language development. In these cases, FAS was named a motor speech discarder and not a clinical syndrome. This further supports the idea that FAS can be caused by a rewiring of neural connections.
Click to access 81-85.pdf
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Very true. I also read about her case study as well. Since there aren’t a lot of studies already, with only 100 documented cases, it’s not hard to run into one that I’ve already looked upon that you all have mentioned. I find it funny that you mentioned Tennessee. I was born and raised in TN for 21 years and then moved to California for 3 years. The accent change is very large since, in my opinion, Californians don’t have an accent. I still to this day don’t think they do; it’s very plain sounding. However the northerners (here in PA) and like NY as you mentioned, are very different again from the west coast and the South.
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After reading about FAS, I wondered whether the so-called “foreign accent” that is attributed to individuals diagnosed with FAS is really a specific foreign accent at all or whether, in an attempt to make sense of changes in speech patterns, listeners perceive certain accents based on their exposure to different speech patterns. Listening to video recordings of these patients, I can detect unusual speech patterns but I’m not sure they can be attributed to a specific foreign accent. Rather, I think it is a subjective experience in which the listener’s brain scans for familiar sounds and assigns them to a category (e.g., an english or chinese accent). Clearly, people diagnosed with FAS have had their normal speech patterns disrupted in some way, and that may be upsetting because their identity is challenged. However, it may not be the syndrome that we think it is. The author of this blog is of the same opinion: https://mmcneuro.wordpress.com/2013/07/21/foreign-accent-syndrome-their-problem-or-yours/
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Chelsbrain, that is exactly what I was thinking as I was doing my research. I often times wondered if it was just them sounding similar to a deaf person speaking and not so much a foreign accent because no one can really pinpoint what accent territory it comes froms. Ellen Spencer, the lady I interviewed, is an advocate for FAS and I remember her telling me that for the Outrageous Acts of Science show, they had a world renowned foreign accent specialist come in to see if she could pinpoint the location of her accent or if it was fake. The doctor could not pinpoint a specific location, mixing them from Sweden, Germany, and French, but also noticed that by her facials movements and actions that Ellen was not faking this at all. It’s absolutely amazing how even a specialist in a field like this can rule out a poser or the real thing.
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While I was reading your blog, I also thought that the particular “foreign accent” that Ellen had was not actually an accent, but her brain trying to communicate with different sounds and patterns. That’s so interesting how the specialist could not identify the accent!
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Hi Theresa! Regarding the dentist case study, did they ever suggest Trigeminal nerve issues? I’m in the Dental field and also pursuing dentistry after my bachelors. When numbing on the lower jaw, there’s always a risk of paralyzing the patients jaw and facial features temporarily. If this ever happens, patients can experience this for hours to a few days, sometimes weeks. It’s rare that it occurs for a few months but I have seen it happen. Also, when I was talking with Ellen about FAS, she was mentioning that stroke patients often have lesions on the brain (I also found this is my research.) FAS is not always caused from lesions. It’s actually the most rare way it’s caused. Most of the time it’s disrupted from head injuries, headaches, memory loss. Strokes can definitely make it worse or even agitate it. This is however a great unknown topic!
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Hi Victoria, the case study I read about did not mention anything about Trigeminal nerve issues. They stated that they were uncertain about what caused her speech to change , but it could be possible that damage to certain nerves during the dental surgery did alter her speech. The affected woman did make the comment that she did not mind her new speech pattern, that she even kind of liked it. I know that several of the affected people that I was reading about were having identity issues because of their new speech patterns, and would prefer to return to their normal voices. But like I said, this woman actually enjoys the new sound of her voice.
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This is a new one to me, I had never heard of Foreign Accent Syndrome before reading your blog. It just seems so strange that a person could develop a foreign sounding accent as a result of suffering a stroke or a brain injury. I mean of all the consequences that could occur, why would a person develop that particular foreign accent? I agree with you that more research needs to be done so we can learn more about this syndrome. I did look up some information about the syndrome online and read about a fascinating case where a woman developed FAS after being anesthetized by her dentist so that she could have some teeth extracted. Her dentist told her that her speech would return to normal after the swelling in her mouth went down, but her speech never did recover. She was eventually diagnosed with FAS. They are not sure why it happened and think she could possibly have had a small stroke while she was under, but they are not sure because she has not had a brain scan yet, which as you mentioned in your blog, is necessary to correctly diagnose this syndrome. Another case I read about stated that one woman developed a foreign accent after having a stroke, and then after she had a second stroke, her speech went back to normal. I also read that FAS usually only affects certain aspects of speech such as intonation and stress whereas strokes and brain injuries cause greater damage to speech.This really is an engrossing topic, and one that I would like to learn more about.
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