User:Khuang35/Palilalia

Palilalia (from the Greek πάλιν (pálin) meaning "again" and λαλιά (laliá) meaning "speech" or "to talk") is an acquired speech disorder characterized by the involuntary repetition of syllables, words, or phrases. It has features resembling other complex tics such as echolalia or coprolalia, but unlike other aphasias, palilalia is based upon contextually correct speech. It was originally described by Alexandre-Achille Souques in a patient with stroke leading to left-side hemiplegia.

Classification
Palilalia may occur in conditions affecting the pre-frontal cortex or basal ganglia regions of the brain, either from physical trauma, neurodegenerative disorders, genetic disorders, or a loss of dopamine in these brain regions. Palilalia occurs in a variety of neurodegenerative disorders, occurring most commonly in Tourette syndrome, Alzheimer's disease, and progressive supranuclear palsy. Palilalia is considered hyperkinetic disorder of the vocal cords. As basal ganglia function is impaired, commands sent to the vocal cords are unfiltered, resulting in the characteristic repetition of words or syllables.

Signs and Symptoms
Palilalia is defined as the repetition of the speaker's words or phrases, often for a varying number of repeats. Repeated units are generally whole sections of words and are larger than a syllable, with words being repeated the most often, followed by phrases, and then syllables or sounds. The reiterative elements most often appear at the end of a word or phrase, but may also occur at the beginning or midportion. Palilalic repetitions are often spoken with decreasing volume and speed up over time.

A 2007 case study done by Van Borsel et al. examined the acoustic features in palilalia. AB, a 60 year old male was diagnosed with ideopathic Parkinson's disease and had noticed changes in gait, posture, writing, and speech. Observation of his perceptual speech characteristics and Frenchay Dysarthria Assessment results suggested AB suffered from hypokinetic dysarthria with a marked palilalia. It was determined to start speech therapy with passive (metronome) and active (pacing boards) pacing techniques to reduce the number of palilalic repetitions. Unfortunately AB was not able to enunciate despite extensive training.

Analysis of AB's speech therapy showed his repetitions lasted from 1 minute 33 seconds to 2 minutes 28 seconds, ranging from 1 to 32 repetitions on some words. Pauses were present between each repetition, ranging from 0.1 to 0.7 seconds. Van Borsel et al. concluded that AB's palilalic repetitions followed no pattern: the duration of each repetition train did not decrease over time, the number of repetitions per train did not increase, and the duration of each individual word did not decrease in duration. Such results indicated not all palilalic repetitions show an increasing rate with decreasing volume, and defied the two distinct subtypes of palilalia as suggested by Sterling. Ab showed neither a systematic increase (Sterling's Type A) or a constant duration (Sterling's Type B) and instead fell between the two.

Causes
Although the exact cause of palilalia is unknown, the symptoms of palilalia suggest changes in the basal ganglia/striatum, thalamus, or damage to the fibers linking the cerebral cortex to subcortex structures.

In cases of physical trauma induced palilalia, damage to the brain is often in the pre-frontal cortex region, more specifically the basal ganglia. Palilalia also occurs in a variety of neurodegenerative disorders, occurring most commonly in Tourette's syndrome, Alzheimer's disease, and progressive supranuclear palsy.

Palilalia has also been reported as a side effect of some medications, such as clozapine and levodopa, where it is believed medications interfere with dopamine in these regions of the brain.

Diagnosis
Palilalia must be differentiated from other complex tic disorders such as stuttering, echolalia, or logoclonia. In contrast to stuttering or logoclonia, palilalic repetitions tend to consist of complete sections of words or phrases. Furthermore, repetitions are often repeated many times, sometimes as many as fifty times. Unlike echolalia, palilalic repetitions are often the speaker's own words, rather than words spoken by others.

Treatment
Treatment for palilalia is often given in the form of speech therapy, focusing on slowing down speech rate and emphasizing enunciation. Passive or active pacing techniques can assist in controlling repetitions. Sometimes trazodone has been effective in controlling palilalia.