Slide 1 Mississippi Speech, Language & Hearing Association, 2014

A NeuroAudiology View of CAPD: Auditory Hallucinations & Dyslexia

Frank E. MusiekNeuroAudiology LabUniversity of Connecticut

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Slide 2

The following are key slides and information for my presentation. The handouts will not contain all slides (sorry). - FM

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Slide 3 Underpinnings of CAPD

• Human & animal pathologic data– Neff 1961 to Bamiou et al. 2007

• Complete central deafness

- >50 cases

• Functional imaging data

- Hugdahl et al. 1997

• (Central test data) showing laterality effects

- Baran et al. 2004

• Differential AEP data

- Kileny et al. 1986, Knight 1989

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Slide 4 Etiologies of CAPD

• Mass lesions• Extrinsic brain damage (trauma, metabolic, Lyme

dis, heavy metals, herpetic encephalitis etc. *hyperbilirubinemia)

• Epilepsy ( TLE, Landau Kleffner) • Vascular lesions• Developmental disorders (ADHD, Lang., dyslexia,

other LD) • Degenerative• Deprivation• Aging• Surgical effects• Others = Psychiatric ?

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Slide 5

-Neurological disorders

-Maturational Lag

-Neuromorphological

-Polymicrogyri

-Heterotopias (ectopic areas)Dyslexia

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Slide 6

Schizophrenia, Auditory Hallucinations, & Dyslexia and

Central Auditory Processing

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Slide 7 How do we improve and expand audiology ?

• New tests

• New rehab.

• New instrumentation & technology

• New Populations

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Slide 8 Schizophrenia Statistics

• According to the Nation Institute on Mental Health about 1% of Americans have been diagnosed with schizophrenia.

• One of the most common symptoms of schizophrenia are auditory hallucinations, which are experienced by over 70% of schizophrenics (Hugdahl et al, 2007).

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Slide 9

From Waddington

Surface Auditory (peri-Sylvian) Regions (Based on Celesia 1976, & multipleFunctional imaging studies)

-Frontal lobule (prefrontal cortex)

-Central gyri

-Angular gyrus

- SMG

- STG

- MTG ?

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Slide 10

5(Musiek)

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Slide 11 Highley, J., McDonald, B., Walker, M., Esiri, M., & Crow, T. (1999). Schizophrenia and

temporal lobe asymmetry: A post-mortem stereological study of tissue volume. British Journal of Psychiatry. 175:127-134.

• The purpose of this study was to look at the structure of the brains of patients with schizophrenia to determine if there was a reduction in tissues volume.

• Studied the temporal lobes of the brains of 29 patients with schizophrenia and 27 controls, post-mortem.

• They found a significant left-sided reduction in the superior temporal gyrus in both males and females with schizophrenia.

• They also noted that the total volume of temporal lobe grey and white matter was also significantly reduced.

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Slide 12 Hirayasu, Y., McCarley, R., Salisbury, D., Tanaka, S., Kwon, J., Framin, M., Snyderman, D., Yurgelan-Todd, D., Kikinis, R., Jolesz, F., & Shenton, M. (2000) Planum temporale and Heschl gyrus volume reduction in schizophrenia: a magnetic resonance imaging study

of first episode patients. Arch Gen Psychiatry. 57: 692-699.

• Looked at abnormalities of Heschl’s gyrus and the planum temporale (primarily left) in patients with schizophrenia, manic psychosis, and normal controls.

• Found that patients with schizophrenia had reduced left planum temporale volume than controls and patients with manic psychosis.

• Heschl’s gyrus gray matter volume was also reduced in

schizophrenics compared to the other 2 groups.

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Slide 13

Hirayasu et al (2000)

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Slide 14 Disorders Associated with Auditory Hallucinations (AH) (non Pharmalogical)

Psychiatric

Schizophrenia

Neurologic (Central auditory disorder)

Damage to central auditory cortex

Otologic

Deprivation

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Slide 15 Prevalence of Auditory Hallucinations

• 2-3 % of Adults have experienced AH(Remschmidt, 2002)

• 32% of elderly (Tien, 1991; Cole et al. 2002)

• More common in women (Remschmidt, 2002)

• The most common AH = one’s name (Sach’s 2012)

• Verbal more common than musical

• What about false thresholds for tones or speech ???

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Slide 16 Is it the AH or SZ that results in

reduced volume of auditory cortex ?

• Daly et al. 2007

• Glaser et al., 2004

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Slide 17 Changes in auditory neural substrate-summary-

• Decrements in auditory cortex size in patients with schizophrenia

• Primarily those with AH !

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Slide 18 Study Aud. Frontal Thal. Cing. other

Sukhwinder.. X X X X X

Jardri X X X

Copolov X X

Van de Ven X ? X

Lennox X X

Liemburg X X X

Musiek, 2014

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Slide 19 Brain activity during AH-summary-

• There is brain activation during AH

• Though there is anatomical variability, auditory cortex is consistently involved.

• In cases of intermittent AH, activity is seen when AH is present and not or severely reduced when it AH are absent

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Slide 20

SCHIZOPHRENIA

Electrophysiology

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Slide 21

Schizophrenia (AH) patients are likely to have abnormal responses across a variety

of auditory evoked potentials.

IHTT is greater for Schizophrenia with AH

Electrophysiology , Schizophrenia,Auditory Hallucinations

-summary-

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Slide 22

SCHIZOPHRENIA

Behavioral Results

- Dichotic listening

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Slide 23

Behavioral tests and Schizophrenia (AH)-summary-

Dichotic listening performance is sub par, often affecting the REA

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Slide 24 Neurologic Based AH

• Head Injury (Sachdev, et al. 2001)

• Stroke of Brainstem, Auditory Cortex

– Symptoms subside over time (Lampl, et al 2005; Noda et al. 1993)

– Musical AH, Rt. Aud. Cortex (Augustin et al., 2001)

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Slide 25

OTOLOGIC VS. NEUROLOGIC VS. PSYCHIATRIC

“a thorough otological history and examination including audiology isa necessary component of the assessment of a personwith auditory hallucinations.” (Brasic & Perry, 1997; Gordon, 1997)

Auditory Hallucinations……..

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Slide 26 Auditory Deprivation !

- Especially in the elderly (Charles Bonnett Syndrome)

(Berrios, 1990, Musiek et al. 2007)

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Slide 27

DYSLEXIA

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Slide 28

Hynd et al.

Insula

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Slide 29 Corpus Callosum

Based on Hynd ‘90’Bassett, Musiek

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Slide 30

Heterotopias (ectopic areas)- Neuronal migration disorders have been involved in various pathologies, including epilepsy,Dyslexia, schizophrenia & others ? these data suggest that neuronal migration disorders may constitute a morphologicalbasis for these pathologies. (N. Chevassus-Au-Louis*, et al. 1998)(Migrations of yielding nests of cells in the wrong loci)

Heterotopias

Neuromorphological (2)

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Slide 31

Polymicrogyria

Polymicrogyria (PMG) is a developmental , neuronal migrational malformation of the human brain characterized by an excessive number of small convolutions (gyri) on the surface of the brain. Either the whole surface (generalized) or parts of the surface (focal) can be affected. Fused laminae & lack of columnar organization.Noted in a variety of developmental disorders (multiple sources)

Neuromorphological (3)

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Slide 32 Boscariol, M., (2009) Auditory processing disorder in perisylvian syndrome,Brain & Development

Polymicrogyri (PMG) (dyslexia)

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Dichotic Digits Random Gap

PMG ControlsPMG Controls

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Slide 33

Some animal experiments…

Disruption of neural migrational patterns-focal freeze lesions

-folding of brain tissue

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Slide 34 CAPD/Dyslexia Studies

Study Age Significant Findings

Yes No Mixed

Schochat & Simoes(2010)

7-12 years X

Marques de Oliveraet al. (2010)

8-16 years X

Veuillet et al. (2011) X

Billiet & Bellis (2011) School agechildren

X

Hamalainen et al. (2011)

Adults X

Iliadou et al. (2010) Adults X

Diaz et al. (2012) Adults X

Schulte-Korne & Bruder (2010)

Children andadults

X

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Slide 35 Dyslexia Summary……

1. Even in children with learning problems, neurologicalabnormalities can exist.

2. Maturational delays (myelin) can also be a factor

3. Alterations in brain development impacts structure & function.

4. These neurological, maturational neuromorphologicalabnormalities conspicuously can & seem to involve auditory regions and likely translate into Central auditory dysfunction.

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