Caveat lector: This blog is where I try out new ideas. I will often be wrong, but that's the point.

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There's a fascinating, very short report out in JAMA marking the first case where text messaging abnormalities were the first signs of a neurological abnormality.

The paper, "Dystextia - Acute Stroke in the Modern Age", documents the case of a pregnant woman who suffered a small "acute ischemic infarction" (stroke) in her left insula (below). As per medical radiological tradition, the right side of the brain image represents the left side of the patient's brain, because they flip them (supposedly because that's how they see the patients when they're facing them?)

She was brought into the emergency room after the following text message conversation with her husband about their baby's due date (P - patient; H - husband):

H: So what’s the deal?
P: every where thinging days nighing
P: Some is where!
H: What the hell does that mean?
H: You’re not making any sense.
H: July 24, right?
P: J30
H: July 30?
P: Yes
H: Oh ok. I’m worried about your confusing answers
P: Butithink
H: Think what?
P: What i think with be fine

What's interesting about this is that the patient had been hypophonic (soft speech) due to a recent upper respiratory illness, which the authors conclude may have masked her strange speech patterns:
"As the accessibility of electronic communication continues to advance, the growing digital record will likely become an increasingly important means of identifying neurologic disease, particularly in patient populations that rely more heavily on written rather than spoken communication."
While this is a cool presentation of modern technologies encroaching upon the medical world, what's fascinating to me, from a neuroscientific perspective, is the location of her stroke and its effects. In 1996 Nina Dronkers scanned the brains of 25 patients with apraxia, or the inability to coordinate speech movements, and found that 100% of the patients had lesions in only one spot: the left insula (which was also found to be lesioned when she performed MRIs of Broca's original patients).

This is an old argument, but provides strong evidence that the insula is an important player in coordinating speech movements.

Even if that "speech" is actually just texting on your iPhone.

Ravi, A., Rao, V.R., & Klein, J.P. (2012). Dystextia: Acute Stroke in the Modern AgeDystextia Archives of Neurology DOI: 10.1001/jamaneurol.2013.604
Dronkers, N. (1996). A new brain region for coordinating speech articulation Nature, 384 (6605), 159-161 DOI: 10.1038/384159a0
Dronkers NF, Plaisant O, Iba-Zizen MT, & Cabanis EA (2007). Paul Broca's historic cases: high resolution MR imaging of the brains of Leborgne and Lelong. Brain : a journal of neurology, 130 (Pt 5), 1432-41 PMID: 17405763


The Monster Under the Bed

The piece below was written last night by my PhD advisor, co-author, collaborator, friend, and mentor, Robert T. Knight, M.D. I'm posting it verbatim without comment, with his permission.


Children often worry about the monster under the bed. Fortunately, adults can assuage that scary feeling with warmth and love and children eventually learn that monsters are a figment of their imagination. Now the monster under the bed is real, and the fear inside of the children of the land is palpable. Sadly, the horrible loss of twenty precious little joyful kids is only the surface of the damage the young man with the assault weapon inflicted on our children.

Yes, children are resilient – and some pundits will say ‘don’t worry, kids will deal with it with no long-term damage in most cases’. Don’t believe them for a minute. Being tough and resilient is different from having the magic of childhood ripped away.

We adults have collectively elected to inflict this on our children. And I do not mean only the NRA officials, the gun lobbyists, the gun-company owners or the politicians who implicitly condone ‘guns of war’ entering our schools. I mean all of us, all adults who are collectively responsible for the precious gift of childhood. We have all abdicated our solemn obligation to our children.

What to do? First, we need immediate changes to how we deal with gun ownership in this country. As a neurologist, I am required to report to the Department of Motor Vehicles any patient who is having cognitive changes such as marked Alzheimer’s disease that precludes him or her from driving safely. Similarly, I am required to report anyone with a likelihood of losing consciousness that is not under control with medications. Any rational person would not want someone losing control of their car and plowing into 20 defenseless children in the local schoolyard, yet we let the same carnage happen with a gun in the hands of unstable people. Perhaps we need to examine whether health care professionals have a responsibility to report patients with a propensity for violence to gun licensing agencies. We already have such a reporting requirement for anyone who is actively suicidal or homicidal.

And to what end are we deluged with guns? So that gun enthusiasts can handle their sleek toys and feel the power of weapons that have now been turned against our children? The logic that each American has the inalienable right to any firearm is profoundly flawed. By this line of thought a ‘gun enthusiast’ should be able to have a 50-caliber armor-piercing machine gun. Presumably, the excitement derived from shooting one projectile would be magnified by shooting an even bigger missile of death. Assault weapon aficionados should logically agree that owning a bazooka is their right. Why not surface-to-air missiles providing an even bigger rush?

All this so that we can have a ‘silent militia’ to protect our country? A ‘silent militia’ is a concept that exists only in the minds of the paranoid: we already have the greatest and most loyal fighting forces ever assembled on the face of the earth. Or so that we can ‘Live Free or Die’? Spare us all the John Wayne movies – which, by the way, I thoroughly enjoy. A word about NRA members is warranted. Let me divulge that I was a shotgun owner and hunter as a kid in rural New Jersey, like virtually every other boy in my small rural town. I am a supporter of the Second Amendment to the Constitution and certainly all NRA members feel the same. But most NRA members do not support unbridled access to guns that have no place in hunting and are vehicles of war.

Why are we at this juncture? How is it that twenty innocent children could be slaughtered so easily, by a disturbed 20-year-old with a lethal military-grade weapon? Let’s look inward. The failure to stand up to the powerful gun lobby is a failure of our collective responsibility to protect our children. Look not to the NRA Headquarters; look to yourself, YOU are responsible. Lack of action is action.

How do we break this cycle of adult irresponsibility that plagues the nation and has taken joy from so many family members in Newtown? What, then, to do? Obviously, new licensing approaches is a must. Current Federal laws on gun purchase need to be extended to gun shows, internet and inter-personal sales. I’d go further. I’d personally prefer a recall of all assault weapons -- a move that has worked well in other countries. But I must assume this is a non-starter in the USA. Rather, we, the protectors of childhood, should lobby our elected officials to ban the sale of assault rifles, large clips, armor piercing-bullets and body armor. These sales are unconscionable – it is simply unheard of in other first-world nations.

The NRA leadership should be ashamed that they are not advocating strongly for this change. Of course, as usual, shame seems to be tempered by profit. The bottom line is money in the pockets of the NRA leadership, their lobbyists, and the gun company owners. Every retirement fund or company holding shares in any company making assault weapons for public purchase needs to divest all their holdings NOW. If they don’t comply, WE must remove our funds and use our purchasing power by boycotting these companies. Neuroscience and common sense has shown that the fear of public shaming is perhaps the biggest stress anyone can endure. Maybe we circulate the names of the top 100 NRA leaders, lobbyists and automatic weapon manufacturers, making sure we know where the purveyors of death reside.

Am I being extreme? I certainly hope so. The NRA is not the problem. We – the adults of the United States of America – are the problem. We have abdicated our sacred responsibility to our children. Do not expect politicians alone to change this. Only the concerted efforts of all of us will change a culture of gun violence. People who fail to act now must assume partial responsibility for the next death of a child. Stop the Monster Under the Bed before the fabric of childhood freedom, safety, happiness and magic is irretrievably cut.

Robert T. Knight, M.D.
Professor of Psychology and Neuroscience
University of California, Berkeley