N Transcortical Motor Aphasia

Transcortical motor aphasia (TCMA) involves lesions of the left frontal lobe-supplementary motor area (SMA), just anterior and superior to Broca's area. During acute phases, patients may initially present as mute but later develop a clinical profile characterized by normal repetition and comprehension, with limited, slow, and perseverative spontaneous speech.

Some researchers hypothesize that the SMA represents the "starting mechanism'' or center for initiation of speech. Others suggest that damage to the SMA results in a lack of a plan or program to carry out voluntary speech. In their 1984 study, Morris Freed-man and colleagues studied 15 patients with TCMA or near variants of the syndrome. Consistent with TCMA literature, these researchers concluded that small lesions to SMA cause a pure disorder of speech initiation. Furthermore, damage to fibers from SMA to premotor cortex may disconnect the limbic starter mechanism of speech from the cortical regions that control the motoric aspect of speech.

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