OPPOSITE HALF-BRAIN DOMINANCE OF SPECIFIC
FUNCTIONS? ANOTHER CASE IN A DOWN CHILD
UNDER DRUG THERAPY
Renato COCCHI MD, a neurologist
and a medical psychologist
Summary.
The
emerging of opposite words, in a Down's syndrome girl aged eight, is reported
aiong with her development and drug therapy course since she was
20 months. The use of the opposíte word in normal language seems limited
to the semantic field without any emotional involvement
Suggested
explanation refers to the poor functíon of the mechanísm suppressíng the
opposíte engram.
This
fact accounts for supposed temporary opposite half-brain dominance for only a
part of the semaníic field, sometimes dealing with the
emerging of the opposite word.
Key
words: opposite words, semanííc field, Down's syndrome, gírl, defectíve
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 emotonal 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 patological, may be due to defecfive 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 ínverse 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, oppositon 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 Matdces
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 foot note 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 consultaton, confirmed the fact. This emerging of the
opposite did not involve only emotonal thinking.
Now I shall report another case in a Down
female child with a detailed follow-up of her therapy course.
The case.
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.
Step-parents brought her for consultation
when she was 20 months. They did not report foetal troubles. Born postmature in
her 43th week, she had 3120 g birthweight and pathological blood bilirubin.
Autonomous walking reached when she was 16 months. I recorded then: Upper
respiratory tract infectons' (URTI) easiness, nystagmus and squint, oral
mucosal surface's stimulation by her hands. Moreover I noted hyperkinesis, some
spastic constipaton, 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-words 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
stimulafion 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-methioníne 200mg,
carbamazepine 50mg, díazepam 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 altemafing 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 stimulaton 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 míneral 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 wìnter she had often colds and cough.
Nystagmus fully went off but altemating 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 ~(Eg. "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, díazepam 2mg.
In May 1998, when the girl was 9;4 the
parents came with her for another checkup. She is running lst 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
behawour 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 norrnally and has regular bowel funclion; 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 frequenfly 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.
Discussion.
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 wdting 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 (lst 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-líke behaviour, but the
handling of objects can become reversed too (Feinberg and Jones, 1985).
These last researchers suggest that
left-right orientaton be not a unitary ~haracteristic. They maintain it can
have a link to differenfial 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 intemal 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
negatve 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 strutture 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 behawour of this child?
The emergence of it in the developmental
age and during language acquisítion is surely quite an important feature. As
for the second one, we have the mental retardation línked 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 semanfic 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 opposíte behaviour. lt could be only a moment during normal language
acquisition, like physiological dyslexia during leaming to read, but this sole case
in my casuistry does not support this hypothesis. lf 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.
Conclusion.
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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Author's address: dr Renato COCCHI, via Rabbeno, 3,
Reggio Emilia (Italy).
renatococchi@libero.it