Acute Aphasia in Childhood and Adolescence: Age Effects on Functional Recovery

Background: A perinatal left hemispheric infarct can, in most cases, be well compensated with respect to language. At this early developmental stage, not only perilesional, but also contralesional reorganization of language can support functionally successful compensation. Data on infarcts acquired in childhood and adolescence is, however, less clear. After language acquisition, left-hemispheric infarcts often cause aphasia, with variable recovery. Patients with persistent aphasic symptoms document an obvious lack of a successful reorganization. The age at infarct probably significantly influences the compensatory potential, but literature on this matter is scarce.

Method: In a cooperative project of Schön Klinik Vogtareuth (Clinic for Pediatric Neurology and Neurological Rehabilitation) and the University Children’s Hospital Tübingen (Pediatric neurology), we first identified all patients treated for a left-hemispheric infarct between the age of 2 months and 17 years. All patients with documented aphasia in the acute phase were asked to complete a short questionnaire regarding language functions (production, comprehension, reading, and writing).

Results: Of the 35 patients addressed, 24 patients (69%) returned the questionnaire. One patient was deceased, for another patient no current address could be obtained. For the whole group, the majority of patients reported “no” (13/24) or “some” (7/24) language problems, only 3 of 24 reported considerable problems (in more than one area). All six patients who had suffered the infarct before the age of 5 years reported no language problems, two patients who were 5 years old at the time of the infarction reported “some” problems. Considerable problems were reported only by patients aged 7 years and older.

Discussion: Up to the age of 4 years, good recovery of language function seems to be the rule, even after extensive left-hemispheric infarcts. After that age, residual aphasic symptoms may persist. Obviously, the time frame in which an effective right-hemispheric language reorganization is possible seems to close around the age of 5 years. Additional factors, such as epilepsy and intellectual abilities, must be considered in future studies.