Amyotrophic Lateral Sclerosis and Language Dysfunction: Kana, Kanji and a Prescient Report in Japanese by Watanabe (1893)

Although Charcot described amyotrophic lateral sclerosis (ALS) in the 1870s, he did not focus on language. And language problems in ALS with or without dementia were long ignored. A recent report by Caselli et al. [Ann Neurol 1993;33:200-207] is accurately regarded as a major breakthrough in studies of language in ALS. However, we discovered a Japanese account written by Watanabe in 1893 describing paragraphia of an aphasic nature, and this is interesting for two reasons. (1) Watanabe's paper is, we believe, the first report of an aphasia associated with motor neuron disease, and predates other reports by 100 years. (2) It sheds light on the dissociated involvement of the two Japanese writing systems: kana (Japanese simple phonograms) and kanji (Japanese morphograms with complex character derived from Chinese characters). In the aphasia reported by Watanabe, the phonograms are more affected than the morphograms. Thus, Watanabe's clinical observation may predict current theories of the way in which these two writing systems involve different intrahemispheric pathways.