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Opposite Half-Brain Dominance of Specific Functions? Another Case in a Down Child Under Drug Therapy
|Author article list|
Renato Cocchi M.D., Ph.D. (Sociology)
Italian Journal of Intellective Impairment 11 (2): 151-154 (1998 Dec)
Reprinted with the permission of Renato Cocchi|
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Key words: opposite words, semantic field, Down's syndrome, girl, defective brain dominance, opposite engram, suppression mechanism.
Following a speculative paper on defective hemispheric dominance and cognitive behaviour (Cocchi, 1994), I wrote a pioneering paper on opposite emotional thinking. I reported the case of a woman already treated for a schizoid-affective illness (Cocchi, 1996). In it I confirmed the idea that several incongruous behaviours, both normal and pathological, may be due to defective half-brain dominance In the first paper (Cocchi, 1994) I asserted that such a opposite mechanism could have been a temporary, stable or stabilized brain inverse dominance for areas, structures or functions.
To give support to this view, I recalled many data, several of which derived from common evidence. From neurology I pointed out mirror writing, reading and speaking in brain injured people, and the mirror focus in epilepsy. The "no" stage in infancy, opposition and a higher incidence of left-handed among mentally defective or brain damaged children, come from child neuro-psychiatry. The same is for contrariness in adolescent age. Psychology gave me the so-called "janusian" thinking, the use of paradoxical orders in psychotherapy. In addition I added data derived from digit spans and Raven's Coloured Matrices in alcoholics, demented or college students. The "contrary Mary" [In Italy: the "Bastian Contrario"] came out from the folklore. Finally adult psychiatry contributed with negativism in certain psychoses and with the "dissociate" behaviour of drug addicts.
In a footnote of this first case paper (Cocchi 1996) I briefly reported a second case of an ophthalmologist physician who came to consultation for neurotic depressive symptoms. When I asked after opposite behaviours in his daily life, he admitted that those were his main problem.
Often he did the opposite of what he first thought. In this physician the co-presence of the opposite was usually emerging in a strong way, driving him to contradictory behaviours. His wife who was present to the consultation, confirmed the fact. This emerging of the opposite did not involve only emotional thinking.
Now I shall report another case in a Down female child with a detailed follow-up of her therapy course.
Female, with standard Trisomy 21, she was refused by the parents soon after her birth (the father is a physician) and adopted by another family.
Stepparents brought her for consultation when she was 20 months. They did not report foetal troubles. Born postmature in her 43rd week, she had 3120 g birth weight and pathological blood bilirubin. Autonomous walking reached when she was 16 months. I recorded then: Upper respiratory tract infections' (URTI) easiness, nystagmus and squint, oral mucosal surface's stimulation by her hands. Moreover I noted hyperkinesis, some spastic constipation, poor heat tolerance, poor sweet foods' greediness but normal liking for meat broth.
At that age she was 84cm height and 12.8kg weight.
Her language use did not exceed 10 words without any two-word sentence.
Drug therapy started with glutamine + pemoline 90+10mg, pyridoxine 75mg, tetrahydrofolates 7.5mg, diazepam 1 mg (daily doses).
Thirteen months later, she did not yet suffer from URTI easiness, nystagmus and squint appeared less evident. As for language, vocabulary greatly increased and she normally used two-words sentences. Her height went up to 91.5cm and weight to 14kg.
Current therapy was: glutamine+pemoline 90+10mg, thiamine + pyridoxine + cyanocobalamin 250+250+0.5mg, s-adenosil-l-methionine 200mg, diazepam 2mg.
Two years and half after first consultation she was 100.5cm height and 18kg weight. She used continuously speech and in a better way, and now she can understand double orders. The oral stimulation went down, nystagmus verged to disappear, as in part squint and the so-called Mongoloid face, when not under stress. Neck, hands and feet were less squat. Greediness for sweet things went up. She was no more hyperkinetic.
Current therapy: glutamine 250, thiamine + pyridoxine + cyanocobalamin 125+125+.25mg, s-adenosii-l-methionine 200mg, carbamazepine 50mg, diazepam 2mg.
Thirteen months later, after 41 months of drug therapy, she was 6;3 and had improved in motor skills, although still unable to go downstairs by alternating their feet. Her muscular tone increased; she used going to a swimming pool. URTI limited to some cold and cough.
Her language developed by a better pronunciation, more refined grammatical and syntactical structures, and increased length of sentences. She proved to have got spatial and topographical concepts. Nystagmus had a poor residue and squint became alternating. The child indulged in oral stimulation only in rare occasions. Kindergarten teachers reported that they found her always better. Now she is 106.5cm height and 21.5kg weight. Bed-wetting stopped.
Current therapy: glutamine 250mg, thiamine + pyridoxine + cyanocobalamin 125+125+0.25mg, a compound of vitamins and mineral salts (DIAGRAN MINERALE RAFFORZATO) 1 tablet once a week, tetrahydrofolates 7.5mg, s-adenosil-l-methionine 200mg, carbamazepine 75mg, diazepam 2mg.
One year later, the child came to consultation when she was 7;4. The mother said that she was fairly well, although little whimpering last month. In winter she had often colds and cough. Nystagmus fully went off but alternating squint did not change.
Her language improved with articles, prepositions and correct tenses of verbs in her sentences.
The child's diet now summed bread and pasta, rice, broth, milk and derivatives, fish, meat, cooked vegetables, but eggs, sweets, raw vegetables and fruits in a lesser degree. Bowel function is normal. The way she rides the bike did not progress, and she was yet unable to go downstairs by alternating her feet.
Teachers of her kindergarten found her fairy well and the same at parents' association outpatients' clinic. Now she is 109cm height and 23.5kg weight. Her fingers became longer mainly in her fingernails.
Current therapy: glutamine 250mg, pyridoxine 150mg, a compound of vitamins and mineral salts (DIAGRAN MINERALE RAFFORZATO) 1 tablet per week, tetrahydrofolates 7.5mg, carbamazepine 100mg, diazepam 2mg.
After about one year the child came again to consultation when she was 8;3. Last months she had a period of tiredness also seen at school and in the swimming pool, but now she has partly overcome it. Perhaps this fact should have got a link to a period of her mother bad health. Some regression in motor balance, noise threshold and food choice were all noted. Hyponeophagia reappeared with an increased need for sweet things. Now she is 117.5cm height and 26.5kg weight.
Her memory works well, and her squint regressed. Language improved, but a curious phenomenon came out: The child sometimes uses the opposite word (e.g. "Turn on the radio" for "turn off the radio," "to open" for "to close" and so on). I asked the mother to survey this language feature and to collect the opposite words.
Current therapy: glutamine 125mg, arginine pidolate 250mg, pyridoxine 150mg, a compound of vitamins and mineral salts (DIAGRAN MINERALE RAFFORZATO) 1 tablet per week, tetrahydrofolates 7.5mg, carbamazepine 100mg, diazepam 2mg.
In May 1998, when the girl was 9;4 the parents came with her for another checkup. She is running 1st grade elementary school and can read disyllabic and trisyllabic words. Now she knows the digit sequence up to ten, adds and subtracts one digit to another one digit number. Using up-case letters, she can write syllables under dictation. Her classroom behaviour is fully adequate. She can get more organized and tidy, and has more autonomy in all fields. Now she is eating some raw vegetables and fruits, sleeps normally and has regular bowel function; she is 121.7cm height and 30kg weight. Finally she stopped putting her thumb in her mouth.
The mother collected a series of opposite words more frequently used such as: Hot for cold, and vice versa. The same happens for to turn on to turn off; sweet - salty; high - low; to push - to pull; lunch - dinner, more - less; above - below; in - out; to lift up - to lower, to open - to take away (about a plaster).
Long, large and high give her special confusion. Her father is "high" for "old," and an object is "long" for "large".
Current therapy: glutamine 125mg, pyritinol 50mg, pyridoxine 150mg, a compound of vitamins and mineral salts (DIAGRAN MINERALE RAFFORZATO) 1 tablet once a week, tetrahydrofolates 7.5mg, carbamazepine 100mg, diazepam 2mg.
This is the first case I have found in my series of more than 550 Down syndrome persons I visited. I can say so because since much more than a decade I feel myself sensitized to the problem of the opposite in human perception and speech.
I need to remember here my previous report on this topic.
When subjects have suffered from a cerebral insult, often in form of an ictus, but also as the result of an accidental trauma or neurosurgery, mirror actions can appear.
We can see mirror writing and/or reading (Critchley 1928; Paradowski and Ginzberg, 1971; Streifler and Hofman, 1976, Fisher, Liberman and Shankweiler, 1978; Heilman, Howell, Valenstein and Rothi, 1980; Tankle and Heilman, 1982; Feinberg and Jones, 1985) or even mirror speaking (1st case described by Cocchi et al., 1986). Mirror behaviours are opposites, at least space opposites.
There is an explanation supported also through animal research (Orton, 1928; Noble, 1968; Bradshaw, Nettleton and Patterson, 1973). Perceptive stimuli, usually visual, produce either one engram and its opposite in the two half-brains in the same time. Normally the brain suppresses the opposite, which has its place in the non-dominant hemisphere.
Under particular conditions this suppressing mechanism becomes inhibited, and so the opposite shows itself as a mirror image. Not only writing, reading and language can take on this mirror-like behaviour, but the handling of objects can become reversed too (Feinberg and Jones, 1985).
These last researchers suggest that left-right orientation be not a unitary characteristic. They maintain it can have a link to differential activation of the cerebral hemispheres, when carrying out motor or other types of tasks. The presence of mirror writing or mirror speaking witnesses double engrams also for internal stimuli like emotional stimuli, as it happened in the woman I reported (Cocchi, 1996).
As I wrote there, in that woman we had to note the presence of compulsory opposite emotional thinking of intrusive type. There is a half-brain asymmetry for emotions, being the right hemisphere where negative emotions surely have more place. (Wittling and Roschman, 1993; Schiff and Lamon, 1994; Schiff and Gagliese, 1994).
As for positive emotions, there is a long-term debate, some researchers asserting the superiority of left half-brain (Sackeim et al., 1982, Coffey, 1987; Davidson and Tomarken, 1989; Davidson et al., 1990; Schiff and Lamon, 1994).
From that we could only imply that right half-brain of that patient was heavily involved in this abnormal verbal behaviour, having her compulsory thoughts very negative emotional contents. The same partly happened in the ophthalmologist whose case I reported in a note of the same paper (Cocchi, 1996).
As for the present case, it shows evidence that opposite behaviours can refer to fields other then emotivity driving to think that this strange mechanism is brain-related, non content-related. Of course, in this Down girl one can suspect a possible weakness of the left half-brain. This behaviour does not necessarily involve the whole non-dominant half-brain, namely the right half-brain, but only a particular function of it.
Where the opposite behaviour comes out, it is the semantic field that is only a part of that complex structure forming the verbal language. Here, for some words, the girl's brain cannot suppress the opposite but this one is the normal choice.
Which are now the features of the opposite verbal behaviour of this child?
The emergence of it in the developmental age and during language acquisition is surely quite an important feature. As for the second one, we have the mental retardation linked to the Down's syndrome. And the third one is the presence of an increased rate of lefthanders among these subjects.
This fact is a signal of problems in half-brain dominance stabilization (Pickersgill and Pank, 1970, Batheja and McManus, 1985, Cordella 1988).
The emergence of opposite words does encompass the whole semantic field in verbal production but only a small part of it. So it gives a raise to new difficulties of interpretation. There appears a segmentation of that semantic field.
At the moment I cannot preview any fate of this opposite behaviour. It could be only a moment during normal language acquisition, like physiological dyslexia during learning to read, but this sole case in my casuistry does not support this hypothesis. If a pathological feature, is it a temporary one or could become a stable behaviour? I have no answers to these questions also because I am lacking any previous experience.
This third case of opposite behaviour seen in the use of verbal language in a Down girl aged eight years shows that we do not face rare events.
The normal dominance for the verbal choice from the semantic field appears to have a partial neuropsychological failure. So it drives to two places (or their brain equivalents) where this choice can be done, the right one and its opposite. It seems yet that this emerging of the opposite could come out from different neuro-psychological functions. It can refer to the disruption of a basic nonspecific mechanism that works for the suppression of the opposite engram.
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