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Jackson ES, Goldway N, Gerlach-Houck H, Gold ND. Stutterers' experiences on classic psychedelics: A preliminary self-report study. JOURNAL OF FLUENCY DISORDERS 2024; 81:106062. [PMID: 38833909 DOI: 10.1016/j.jfludis.2024.106062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 06/06/2024]
Abstract
Stuttering poses challenges to social, occupational, and educational aspects of life. Traditional behavioral therapies can be helpful but effects are often limited. Pharmaceutical treatments have been explored but there are no FDA-approved treatments for stuttering. Interest has grown in the potential use of classic psychedelics, including psilocybin and LSD, which have shown effectiveness in treating disorders with similar symptoms (e.g., anxiety, depression, PTSD). The potential effects of psychedelics on stuttering have not been explored. We conducted a preliminary investigation of self-identified stutterers who report their experiences taking classic psychedelics on the online messaging forum, Reddit. We qualitatively analyzed 114 publicly available posts, extracting meaningful units and assigning descriptor codes inductively. We then deductively organized responses into an established framework of psychedelics which includes behavioral, emotional, cognitive, belief-based, and social effects. These effects were subsequently grouped under organizing themes (positive, negative, neutral). Descriptive statistics revealed that the majority of users (74.0%) reported positive overall short-term effects particularly related to behavioral and emotional change (e.g., reduced stuttering and anxiety), but negative (9.6%), mixed (positive and negative; 4.8%), and neutral overall experiences (11.6%) were also reported. The results support the possibility that psychedelics may impact stuttering, but caution must be applied in their interpretation given the entirely uncontrolled research setting and potential adverse health effects of psychedelics as reported elsewhere. While these results do not encourage the use of psychedelics by stutterers, they suggest that future work could examine the impact of psychedelics on stuttering under supervised and in clinically controlled settings.
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Affiliation(s)
- Eric S Jackson
- Department of Communicative Sciences and Disorders, New York University, USA.
| | - Noam Goldway
- Department of Psychology, New York University, USA
| | - Hope Gerlach-Houck
- Department of Speech, Language, and Hearing Sciences, Western Michigan University, USA
| | - Noah D Gold
- Department of Psychiatry, New York University Langone Health, USA
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2
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SheikhBahaei S, Millwater M, Maguire GA. Stuttering as a spectrum disorder: A hypothesis. CURRENT RESEARCH IN NEUROBIOLOGY 2023; 5:100116. [PMID: 38020803 PMCID: PMC10663130 DOI: 10.1016/j.crneur.2023.100116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/26/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Childhood-onset fluency disorder, commonly referred to as stuttering, affects over 70 million adults worldwide. While stuttering predominantly initiates during childhood and is more prevalent in males, it presents consistent symptoms during conversational speech. Despite these common clinical manifestations, evidence suggests that stuttering, may arise from different etiologies, emphasizing the need for personalized therapy approaches. Current research models often regard the stuttering population as a singular, homogenous group, potentially overlooking the inherent heterogeneity. This perspective consolidates both historical and recent observations to emphasize that stuttering is a heterogeneous condition with diverse causes. As such, it is crucial that both therapeutic research and clinical practices consider the potential for varied etiologies leading to stuttering. Recognizing stuttering as a spectrum disorder embraces its inherent variability, allowing for a more nuanced categorization of individuals based on the underlying causes. This perspective aligns with the principles of precision medicine, advocating for tailored treatments for distinct subgroups of people who stutter, ultimately leading to personalized therapeutic approaches.
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Affiliation(s)
- Shahriar SheikhBahaei
- Neuron-Glia Signaling and Circuits Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, 20892, MD, USA
| | - Marissa Millwater
- Neuron-Glia Signaling and Circuits Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, 20892, MD, USA
| | - Gerald A. Maguire
- CenExel Research/ American University of Health Sciences, Signal Hill, CA, 90755, USA
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3
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Kikuchi Y, Kenjo M, Yoshida E, Takahashi S, Murakami D, Yamaguchi Y, Adachi K, Sawatsubashi M, Taura M, Nakagawa T, Umezaki T. Social anxiety disorder in adolescents who stutter: A risk for school refusal. Pediatr Int 2023; 65:e15622. [PMID: 37690080 DOI: 10.1111/ped.15622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/05/2023] [Accepted: 07/10/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Stuttering is a childhood-onset fluency disorder. Part of the counseling for middle and high school students with persistent stuttering is related to school refusal. Anxiety disorders are known to contribute to school refusal. However, it is not known whether social anxiety disorder (SAD) is a factor in school refusal among adolescents who stutter. METHODS In our first study, we examined the relationship between school refusal and SAD in 84 middle and high school students who stutter; 26% of the 84 students were in the school refusal group and the remaining 74% were in the school attendance group. The second study examined whether SAD was associated with 10 factors related to speech and stuttering frequency using the Japanese version of the Liebowitz Social Anxiety Scale for Children and Adolescents to determine the presence of SAD. Of the 84 students in the first study, 40 participated in the second study. RESULTS The school refusal group of adolescents who stutter had significantly higher rates of SAD than the school attendance group. Fifty percent of adolescents who stutter met the criteria for SAD. Moreover, adolescents who stutter with SAD had significantly higher scores on the items "When speaking in public, do you experience tremors in your limbs?" and "After you stutter, do you have negative thoughts about yourself?" than the adolescents who stutter without SAD. CONCLUSIONS When examining adolescents who stutter, checking for comorbid SAD may lead to better support. Moreover, noticing their repetitive negative thinking, nervousness, and trembling during speech may help to resolve SAD.
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Affiliation(s)
- Yoshikazu Kikuchi
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masamutsu Kenjo
- Department of Special Needs Education, University of Teacher Education Fukuoka, Fukuoka, Japan
| | - Eriko Yoshida
- Faculty of Nursing and Nutrition, University of Nagasaki, Nagasaki, Japan
| | | | - Daisuke Murakami
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yumi Yamaguchi
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuo Adachi
- Voice and Swallowing Center, Fukuoka Sanno Hospital, Fukuoka, Japan
- Adachi Otorhinolaryngology Clinic, Fukuoka, Japan
| | | | - Masahiko Taura
- Department of Otorhinolaryngology, Fukuoka University Hospital, Fukuoka, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiro Umezaki
- Voice and Swallowing Center, Fukuoka Sanno Hospital, Fukuoka, Japan
- International University of Health and Welfare, Fukuoka, Japan
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Abstract
The function of the formation of speech skills is decisive in the development of a child in communication and assimilation of information. Early pediatric diagnosis should become a routine practice of monitoring children from infancy to school age for the timely correction of speech disorders and associated dysgraphia and dyslexia. According to the ICD-10 classification, speech developmental disorders are divided into the following options: articulation impairment, delay in expressive and impressive speech. Articulation disorders, stuttering, impaired expressive speech are the most common and most favorable prognosis for speech therapy interventions. The data on the effectiveness of disorders of the receptive (impressive) language are ambiguous, since there is a high likelihood of a combination with neurogenetic diseases and autism. The development of speech therapy programs will make it possible to broader coverage of those in need of treatment, including complex course therapy with neuropeptides (cortexin).
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Affiliation(s)
- V P Zykov
- Russian Medical Academy Continuing Professional Education, Moscow, Russia
| | - I B Komarova
- Russian Medical Academy Continuing Professional Education, Moscow, Russia
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5
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Busan P, Moret B, Masina F, Del Ben G, Campana G. Speech Fluency Improvement in Developmental Stuttering Using Non-invasive Brain Stimulation: Insights From Available Evidence. Front Hum Neurosci 2021; 15:662016. [PMID: 34456692 PMCID: PMC8386014 DOI: 10.3389/fnhum.2021.662016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/12/2021] [Indexed: 11/21/2022] Open
Abstract
Developmental stuttering (DS) is a disturbance of the normal rhythm of speech that may be interpreted as very debilitating in the most affected cases. Interventions for DS are historically based on the behavioral modifications of speech patterns (e.g., through speech therapy), which are useful to regain a better speech fluency. However, a great variability in intervention outcomes is normally observed, and no definitive evidence is currently available to resolve stuttering, especially in the case of its persistence in adulthood. In the last few decades, DS has been increasingly considered as a functional disturbance, affecting the correct programming of complex motor sequences such as speech. Compatibly, understanding of the neurophysiological bases of DS has dramatically improved, thanks to neuroimaging, and techniques able to interact with neural tissue functioning [e.g., non-invasive brain stimulation (NIBS)]. In this context, the dysfunctional activity of the cortico-basal-thalamo-cortical networks, as well as the defective patterns of connectivity, seems to play a key role, especially in sensorimotor networks. As a consequence, a direct action on the functionality of "defective" or "impaired" brain circuits may help people who stutter to manage dysfluencies in a better way. This may also "potentiate" available interventions, thus favoring more stable outcomes of speech fluency. Attempts aiming at modulating (and improving) brain functioning of people who stutter, realized by using NIBS, are quickly increasing. Here, we will review these recent advancements being applied to the treatment of DS. Insights will be useful not only to assess whether the speech fluency of people who stutter may be ameliorated by acting directly on brain functioning but also will provide further suggestions about the complex and dynamic pathophysiology of DS, where causal effects and "adaptive''/''maladaptive" compensation mechanisms may be strongly overlapped. In conclusion, this review focuses future research toward more specific, targeted, and effective interventions for DS, based on neuromodulation of brain functioning.
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Affiliation(s)
| | | | | | - Giovanni Del Ben
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Gianluca Campana
- Department of General Psychology, University of Padua, Padua, Italy
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Turk AZ, Lotfi Marchoubeh M, Fritsch I, Maguire GA, SheikhBahaei S. Dopamine, vocalization, and astrocytes. BRAIN AND LANGUAGE 2021; 219:104970. [PMID: 34098250 PMCID: PMC8260450 DOI: 10.1016/j.bandl.2021.104970] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 05/06/2023]
Abstract
Dopamine, the main catecholamine neurotransmitter in the brain, is predominately produced in the basal ganglia and released to various brain regions including the frontal cortex, midbrain and brainstem. Dopamine's effects are widespread and include modulation of a number of voluntary and innate behaviors. Vigilant regulation and modulation of dopamine levels throughout the brain is imperative for proper execution of motor behaviors, in particular speech and other types of vocalizations. While dopamine's role in motor circuitry is widely accepted, its unique function in normal and abnormal speech production is not fully understood. In this perspective, we first review the role of dopaminergic circuits in vocal production. We then discuss and propose the conceivable involvement of astrocytes, the numerous star-shaped glia cells of the brain, in the dopaminergic network modulating normal and abnormal vocal productions.
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Affiliation(s)
- Ariana Z Turk
- Neuron-Glia Signaling and Circuits Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, 20892 MD, USA
| | - Mahsa Lotfi Marchoubeh
- Department of Chemistry and Biochemistry, University of Arkansas, Fayetteville, 72701 AR, USA
| | - Ingrid Fritsch
- Department of Chemistry and Biochemistry, University of Arkansas, Fayetteville, 72701 AR, USA
| | - Gerald A Maguire
- Department of Psychiatry and Neuroscience, School of Medicine, University of California, Riverside, 92521 CA, USA
| | - Shahriar SheikhBahaei
- Neuron-Glia Signaling and Circuits Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, 20892 MD, USA.
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7
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Maguire GA, Yoo BR, SheikhBahaei S. Investigation of Risperidone Treatment Associated With Enhanced Brain Activity in Patients Who Stutter. Front Neurosci 2021; 15:598949. [PMID: 33642973 PMCID: PMC7906995 DOI: 10.3389/fnins.2021.598949] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/21/2021] [Indexed: 12/15/2022] Open
Abstract
Stuttering is a childhood onset fluency disorder that leads to impairment in speech. A randomized, double-blinded placebo-controlled study was conducted with 10 adult subjects to observe the effects of risperidone (a dopamine receptor 2/serotonin receptor 2 antagonist) on brain metabolism, using [18F] deoxyglucose as the marker. At baseline and after 6 weeks of taking risperidone (0.5–2.0 mg/day) or a placebo pill, participants were assigned to a solo reading aloud task for 30 min and subsequently underwent a 90-min positron emission tomography scan. Paired t-tests were performed to compare the pre-treatment vs. post-treatment in groups. After imaging and analysis, the blind was broken, which revealed an equal number of subjects of those on risperidone and those on placebo. There were no significant differences in the baseline scans taken before medication randomization. However, scans taken after active treatment demonstrated higher glucose uptake in the specific regions of the brain for those in the risperidone treatment group (p < 0.05). Risperidone treatment was associated with increased metabolism in the left striatum, which consists of the caudate and putamen, and the Broca’s area. The current study strengthens previous research that suggests the role of elevated dopamine activity and striatal hypometabolism in stuttering. We propose that the mechanism of risperidone’s action in stuttering, in part, involves increased metabolism of striatal astrocytes. We conclude that using neuroimaging techniques to visualize changes in the brain of those who stutter can provide valuable insights into the pathophysiology of the disorder and guide the development of future interventions.
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Affiliation(s)
- Gerald A Maguire
- School of Medicine, University of California, Riverside, Riverside, CA, United States
| | - Bo Ram Yoo
- School of Medicine, University of California, Riverside, Riverside, CA, United States
| | - Shahriar SheikhBahaei
- National Institute of Neurological Disorders and Stroke/National Institutes of Health, Bethesda, MD, United States
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8
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Ekhart C, van Hunsel F, van Harten P, van Baarsen J, Yingying T, Bast B. Drug-Induced Stuttering: Occurrence and Possible Pathways. Front Psychiatry 2021; 12:692568. [PMID: 34512414 PMCID: PMC8423914 DOI: 10.3389/fpsyt.2021.692568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Stuttering is a well-known condition that affects mainly children. Often, they recover as they get older. However, a drug-induced form of stuttering may occur at any age. The aim of the present study was to detect drugs that have been associated with stuttering and discuss the mechanisms involved. Method: A descriptive study based on reports submitted to the global pharmacovigilance database VigiBase of the WHO was conducted. Results: A total of 3,385 reports of dysphemia were retrieved from VigiBase. These reports were contributed by 51 countries. Antiepileptics, antidepressants, immunosuppressants, antipsychotics, and centrally acting sympathomimetics were among the most frequently implicated drugs. Conclusion: A wide variety of drugs has been linked to the occurrence or recurrence of stuttering. Several mechanisms, such as increased dopamine levels, reduction of GABA, anticholinergic properties of drugs, or changes in serotonin levels, have been associated with the development of drug-induced stuttering. Paradoxically, agents known to reduce stuttering in some people may induce it in others.
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Affiliation(s)
- Corine Ekhart
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, Netherlands
| | | | - Peter van Harten
- Research Department, Psychiatric Centre GGz Centraal, Innova, Amersfoort, Netherlands.,Department of Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | | | - Tan Yingying
- Linguistic Institute, Shanghai International Studies University, Shanghai, China
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9
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Trenque T, Morel A, Trenque A, Azzouz B. Drug induced stuttering: pharmacovigilance data. Expert Opin Drug Saf 2020; 20:373-378. [PMID: 33337944 DOI: 10.1080/14740338.2021.1867101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Stuttering is a speech disorder characterized by poor fluency of speech despite the speech production organs being normal. Numerous factors contribute to stuttering, and it may also be an iatrogenic effect of certain drugs. The aim of this study was to investigate the association between stuttering and drug exposure.Research design and methods: We investigated the association between drugs and stuttering. We analyzed reports in the World Health Organization global individual case safety reports database (Vigibase) up to 31 May 2020 with the MedDRA lower level terms 'stutter' and 'stuttering.' The association between a drug and the occurrence of the adverse drug reaction was estimated by disproportionality analysis. Reporting odds ratios (ROR) were calculated with 95% confidence intervals.Results: In total, 724 notifications were identified using the MedDRA terms selected. The main drugs implicated were methylphenidate (ROR = 19.58; 95% CI: 13.3-28.8), topiramate (ROR = 12.5; 95% CI: 7.1-22.1), olanzapine (ROR = 12; 95% CI: 8-17.9) and golimumab (ROR = 10.2; 95% CI: 5.5-19.1).Conclusions: When stuttering occurs in a patient treated by drugs affecting neurotransmission, a drug-induced origin of the stutter should be considered.
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Affiliation(s)
- Thierry Trenque
- Reims University Hospitals, Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Reims, France.,Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
| | - Aurore Morel
- Reims University Hospitals, Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Reims, France
| | - Agathe Trenque
- Reims University Hospitals, Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Reims, France
| | - Brahim Azzouz
- Reims University Hospitals, Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Reims, France.,Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
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10
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Busan P, Del Ben G, Tantone A, Halaj L, Bernardini S, Natarelli G, Manganotti P, Battaglini PP. Effect of muscular activation on surrounding motor networks in developmental stuttering: A TMS study. BRAIN AND LANGUAGE 2020; 205:104774. [PMID: 32135384 DOI: 10.1016/j.bandl.2020.104774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/05/2020] [Accepted: 02/17/2020] [Indexed: 06/10/2023]
Abstract
Previous studies regarding developmental stuttering (DS) suggest that motor neural networks are strongly affected. Transcranial magnetic stimulation (TMS) was used to investigate neural activation of the primary motor cortex in DS during movement execution, and the influence of muscle representations involved in movements on "surrounding" ones. TMS was applied over the contralateral abductor digiti minimi (ADM) motor representation, at rest and during the movement of homologue first dorsal interosseous muscles (tonic contraction, phasic movements cued by acoustic signalling, and "self-paced" movements). Results highlighted a lower cortico-spinal excitability of ADM in the left hemisphere of stutterers, and an enhanced intracortical inhibition in their right motor cortex (in comparison to fluent speakers). Abnormal intracortical functioning was especially evident during phasic contractions cued by "external" acoustic signals. An exaggerated inhibition of muscles not directly involved in intended movements, in stuttering, may be useful to obtain more efficient motor control. This was stronger during contractions cued by "external" signals, highlighting mechanisms likely used by stutterers during fluency-evoking conditions.
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Affiliation(s)
- Pierpaolo Busan
- IRCCS Ospedale San Camillo, via Alberoni 70, 30126 Venice, Italy.
| | - Giovanni Del Ben
- Department of Life Sciences, University of Trieste, via Fleming 22, 34100 Trieste, Italy.
| | - Antonietta Tantone
- Department of Life Sciences, University of Trieste, via Fleming 22, 34100 Trieste, Italy
| | - Livia Halaj
- Department of Life Sciences, University of Trieste, via Fleming 22, 34100 Trieste, Italy
| | | | - Giulia Natarelli
- Department of Developmental and Social Psychology, University of Padua, via Venezia 8, 35100 Padua, Italy.
| | - Paolo Manganotti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
| | - Piero Paolo Battaglini
- Department of Life Sciences, University of Trieste, via Fleming 22, 34100 Trieste, Italy.
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11
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Merlo S. Surface Electrical Stimulation for Persistent Stuttering and Concomitant Orofacial Disorders: A Multiple Case Study. Percept Mot Skills 2020; 127:698-721. [PMID: 32233734 DOI: 10.1177/0031512520915027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This multiple case study analysis describes the immediate effects on speech fluency of transcutaneous electrical nerve stimulation (TENS) applied to participants with persistent stuttering and concomitant orofacial disorders. Study participants were 14 adolescents and adults who stuttered and had jaw clenching bruxism or mouth breathing. Participants experienced low-frequency TENS applied at mild motor level for 20 minutes with electrodes placed at the lower third of the face (Area A), submandibular region (Area B), posterior neck (Area C), or shoulder girdle (Area D), with speech fluency assessed immediately before and after each stimulation.For participants with stuttering and bruxism, AB stimulation reduced the median frequency of syllables stuttered by 27% and reduced the median duration of the three highest stuttering moments by 29%. In addition, for participants with stuttering and mouth breathing, CD stimulation reduced the median duration of the three highest stuttering moments by 28% and increased their median speech rate by 113%. As a single session of TENS may help participants with stuttering and concomitant orofacial disorders better use fluency shaping techniques, the therapeutic potential of TENS for treating stuttering should be further investigated.
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12
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Maguire GA, Nguyen DL, Simonson KC, Kurz TL. The Pharmacologic Treatment of Stuttering and Its Neuropharmacologic Basis. Front Neurosci 2020; 14:158. [PMID: 32292321 PMCID: PMC7118465 DOI: 10.3389/fnins.2020.00158] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/11/2020] [Indexed: 01/01/2023] Open
Abstract
Stuttering is a DSM V psychiatric condition for which there are no FDA-approved medications for treatment. A growing body of evidence suggests that dopamine antagonist medications are effective in reducing the severity of stuttering symptoms. Stuttering shares many similarities to Tourette's Syndrome in that both begin in childhood, follow a similar male to female ratio of 4:1, respond to dopamine antagonists, and symptomatically worsen with dopamine agonists. In recent years, advances in the neurophysiology of stuttering have helped further guide pharmacological treatment. A newer medication with a novel mechanism of action, selective D1 antagonism, is currently being investigated in FDA trials for the treatment of stuttering. D1 antagonists possess different side-effect profiles than D2 antagonist medications and may provide a unique option for those who stutter. In addition, VMAT-2 inhibitors alter dopamine transmission in a unique mechanism of action that offers a promising treatment avenue in stuttering. This review seeks to highlight the different treatment options to help guide the practicing clinician in the treatment of stuttering.
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Affiliation(s)
- Gerald A Maguire
- Department of Psychiatry and Neuroscience, School of Medicine, University of California, Riverside, Riverside, CA, United States
| | - Diem L Nguyen
- Department of Psychiatry and Neuroscience, School of Medicine, University of California, Riverside, Riverside, CA, United States
| | - Kevin C Simonson
- Department of Psychiatry and Neuroscience, School of Medicine, University of California, Riverside, Riverside, CA, United States
| | - Troy L Kurz
- Department of Psychiatry and Neuroscience, School of Medicine, University of California, Riverside, Riverside, CA, United States
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13
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Human GNPTAB stuttering mutations engineered into mice cause vocalization deficits and astrocyte pathology in the corpus callosum. Proc Natl Acad Sci U S A 2019; 116:17515-17524. [PMID: 31405983 DOI: 10.1073/pnas.1901480116] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Stuttering is a common neurodevelopmental disorder that has been associated with mutations in genes involved in intracellular trafficking. However, the cellular mechanisms leading to stuttering remain unknown. Engineering a mutation in N-acetylglucosamine-1-phosphate transferase subunits α and β (GNPTAB) found in humans who stutter into the mouse Gnptab gene resulted in deficits in the flow of ultrasonic vocalizations similar to speech deficits of humans who stutter. Here we show that other human stuttering mutations introduced into this mouse gene, Gnptab Ser321Gly and Ala455Ser, produce the same vocalization deficit in 8-day-old pup isolation calls and do not affect other nonvocal behaviors. Immunohistochemistry showed a marked decrease in staining of astrocytes, particularly in the corpus callosum of the Gnptab Ser321Gly homozygote mice compared to wild-type littermates, while the staining of cerebellar Purkinje cells, oligodendrocytes, microglial cells, and dopaminergic neurons was not significantly different. Diffusion tensor imaging also detected deficits in the corpus callosum of the Gnptab Ser321Gly mice. Using a range of cell type-specific Cre-drivers and a Gnptab conditional knockout line, we found that only astrocyte-specific Gnptab-deficient mice displayed a similar vocalization deficit. These data suggest that vocalization defects in mice carrying human stuttering mutations in Gnptab derive from abnormalities in astrocytes, particularly in the corpus callosum, and provide support for hypotheses that focus on deficits in interhemispheric communication in stuttering.
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14
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Yuksel T, Sizer E, Durak H. 2D:4D ratios as an indicator of intrauterine androgen exposure in children who stutter. Early Hum Dev 2019; 135:27-31. [PMID: 31228858 DOI: 10.1016/j.earlhumdev.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/01/2019] [Accepted: 06/04/2019] [Indexed: 11/15/2022]
Abstract
AIM We aimed to explore whether there is a relationship between stuttering and digit ratio (2D:4D), which is thought to be a marker of prenatal testosterone exposure. METHODS We evaluated a total of 90 children who stutter (CWS; n = 40 mild-to-moderate and n = 50 severe stutters) and 40 healthy peers (CWNS) as controls. We used the Clinical Global Impression-Severity (CGIS) scale to measure the severity of stuttering. We measured the lengths of index finger (2D) and ring finger (4D) of both hands directly and divided to calculate 2D:4D ratio. The difference between the right and the left hand 2D:4D ratio (DR-L) was also calculated. RESULT Significant difference was found in right 2D:4D and the mean DR-L between the CWS and CWNS groups. Right 2D:4D was significantly lower in stuttering boys than in control boys, and in stuttering girls than control girls. Also, DR-L was significantly lower in stuttering boys than control boys. In ANOVA, there were significant differences between the mild-to-moderate, severe stuttering and control groups in terms of right 2D:4D and DR-L. Right hand 2D:4D and DR-L decreased from controls to severe stutterers. CONCLUSION Our results suggest that lower right 2D:4D and DR-L were related to the presence and severity of stuttering in children, i.e. CWS had lower 2D:4D and DR-L than CWNS. Further large-scale prospective studies are needed to clarify the reliability of 2D:4D ratio as an indicator of fetal sex hormone exposure level and its relation with the presence and severity of stuttering in children.
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Affiliation(s)
- Tugba Yuksel
- Dicle University School of Medicine, Department of Child and Adolescent Psychiatry, Diyarbakir, Turkey.
| | - Esra Sizer
- Dicle University School of Medicine, Department of Child and Adolescent Psychiatry, Diyarbakir, Turkey
| | - Hasan Durak
- Dicle University School of Medicine, Department of Child and Adolescent Psychiatry, Diyarbakir, Turkey
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Garnett EO, Chow HM, Nieto-Castañón A, Tourville JA, Guenther FH, Chang SE. Anomalous morphology in left hemisphere motor and premotor cortex of children who stutter. Brain 2019; 141:2670-2684. [PMID: 30084910 DOI: 10.1093/brain/awy199] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/04/2018] [Indexed: 02/06/2023] Open
Abstract
Stuttering is a neurodevelopmental disorder that affects the smooth flow of speech production. Stuttering onset occurs during a dynamic period of development when children first start learning to formulate sentences. Although most children grow out of stuttering naturally, ∼1% of all children develop persistent stuttering that can lead to significant psychosocial consequences throughout one's life. To date, few studies have examined neural bases of stuttering in children who stutter, and even fewer have examined the basis for natural recovery versus persistence of stuttering. Here we report the first study to conduct surface-based analysis of the brain morphometric measures in children who stutter. We used FreeSurfer to extract cortical size and shape measures from structural MRI scans collected from the initial year of a longitudinal study involving 70 children (36 stuttering, 34 controls) in the 3-10-year range. The stuttering group was further divided into two groups: persistent and recovered, based on their later longitudinal visits that allowed determination of their eventual clinical outcome. A region of interest analysis that focused on the left hemisphere speech network and a whole-brain exploratory analysis were conducted to examine group differences and group × age interaction effects. We found that the persistent group could be differentiated from the control and recovered groups by reduced cortical thickness in left motor and lateral premotor cortical regions. The recovered group showed an age-related decrease in local gyrification in the left medial premotor cortex (supplementary motor area and and pre-supplementary motor area). These results provide strong evidence of a primary deficit in the left hemisphere speech network, specifically involving lateral premotor cortex and primary motor cortex, in persistent developmental stuttering. Results further point to a possible compensatory mechanism involving left medial premotor cortex in those who recover from childhood stuttering.
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Affiliation(s)
- Emily O Garnett
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Ho Ming Chow
- Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | | | - Jason A Tourville
- Department of Speech Language and Hearing Sciences, Boston University, Boston, MA, USA
| | - Frank H Guenther
- Department of Speech Language and Hearing Sciences, Boston University, Boston, MA, USA.,Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Chang SE, Garnett EO, Etchell A, Chow HM. Functional and Neuroanatomical Bases of Developmental Stuttering: Current Insights. Neuroscientist 2018; 25:566-582. [PMID: 30264661 DOI: 10.1177/1073858418803594] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Affecting 5% of all preschool-aged children and 1% of the general population, developmental stuttering-also called childhood-onset fluency disorder-is a complex, multifactorial neurodevelopmental disorder characterized by frequent disruption of the fluent flow of speech. Over the past two decades, neuroimaging studies of both children and adults who stutter have begun to provide significant insights into the neurobiological bases of stuttering. This review highlights convergent findings from this body of literature with a focus on functional and structural neuroimaging results that are supported by theoretically driven neurocomputational models of speech production. Updated views on possible mechanisms of stuttering onset and persistence, and perspectives on promising areas for future research into the mechanisms of stuttering, are discussed.
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Affiliation(s)
- Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Emily O Garnett
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Andrew Etchell
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Ho Ming Chow
- Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
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Chang SE, Angstadt M, Chow HM, Etchell AC, Garnett EO, Choo AL, Kessler D, Welsh RC, Sripada C. Anomalous network architecture of the resting brain in children who stutter. JOURNAL OF FLUENCY DISORDERS 2018; 55:46-67. [PMID: 28214015 PMCID: PMC5526749 DOI: 10.1016/j.jfludis.2017.01.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 12/28/2016] [Accepted: 01/14/2017] [Indexed: 05/14/2023]
Abstract
PURPOSE We combined a large longitudinal neuroimaging dataset that includes children who do and do not stutter and a whole-brain network analysis in order to examine the intra- and inter-network connectivity changes associated with stuttering. Additionally, we asked whether whole brain connectivity patterns observed at the initial year of scanning could predict persistent stuttering in later years. METHODS A total of 224 high-quality resting state fMRI scans collected from 84 children (42 stuttering, 42 controls) were entered into an independent component analysis (ICA), yielding a number of distinct network connectivity maps ("components") as well as expression scores for each component that quantified the degree to which it is expressed for each child. These expression scores were compared between stuttering and control groups' first scans. In a second analysis, we examined whether the components that were most predictive of stuttering status also predicted persistence in stuttering. RESULTS Stuttering status, as well as stuttering persistence, were associated with aberrant network connectivity involving the default mode network and its connectivity with attention, somatomotor, and frontoparietal networks. The results suggest developmental alterations in the balance of integration and segregation of large-scale neural networks that support proficient task performance including fluent speech motor control. CONCLUSIONS This study supports the view that stuttering is a complex neurodevelopmental disorder and provides comprehensive brain network maps that substantiate past theories emphasizing the importance of considering situational, emotional, attentional and linguistic factors in explaining the basis for stuttering onset, persistence, and recovery.
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Affiliation(s)
- Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.
| | - Michael Angstadt
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Ho Ming Chow
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Andrew C Etchell
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Emily O Garnett
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Ai Leen Choo
- Department of Communicative Sciences and Disorders, California State University East Bay, Hayward, CA, United States
| | - Daniel Kessler
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Robert C Welsh
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
| | - Chandra Sripada
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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Busan P, Battaglini P, Sommer M. Transcranial magnetic stimulation in developmental stuttering: Relations with previous neurophysiological research and future perspectives. Clin Neurophysiol 2017; 128:952-964. [DOI: 10.1016/j.clinph.2017.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 03/14/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
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Busan P, Del Ben G, Bernardini S, Natarelli G, Bencich M, Monti F, Manganotti P, Battaglini PP. Altered Modulation of Silent Period in Tongue Motor Cortex of Persistent Developmental Stuttering in Relation to Stuttering Severity. PLoS One 2016; 11:e0163959. [PMID: 27711148 PMCID: PMC5053488 DOI: 10.1371/journal.pone.0163959] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 09/16/2016] [Indexed: 12/20/2022] Open
Abstract
Motor balance in developmental stuttering (DS) was investigated with Transcranial Magnetic Stimulation (TMS), with the aim to define novel neural markers of persistent DS in adulthood. Eleven DS adult males were evaluated with TMS on tongue primary motor cortex, compared to 15 matched fluent speakers, in a “state” condition (i.e. stutterers vs. fluent speakers, no overt stuttering). Motor and silent period thresholds (SPT), recruitment curves, and silent period durations were acquired by recording tongue motor evoked potentials. Tongue silent period duration was increased in DS, especially in the left hemisphere (P<0.05; Hedge’s g or Cohen’s dunbiased = 1.054, i.e. large effect size), suggesting a “state” condition of higher intracortical inhibition in left motor cortex networks. Differences in motor thresholds (different excitatory/inhibitory ratios in DS) were evident, as well as significant differences in SPT. In fluent speakers, the left hemisphere may be marginally more excitable than the right one in motor thresholds at lower muscular activation, while active motor thresholds and SPT were higher in the left hemisphere of DS with respect to the right one, resulting also in a positive correlation with stuttering severity. Pre-TMS electromyography data gave overlapping evidence. Findings suggest the existence of a complex intracortical balance in DS tongue primary motor cortex, with a particular interplay between excitatory and inhibitory mechanisms, also in neural substrates related to silent periods. Findings are discussed with respect to functional and structural impairments in stuttering, and are also proposed as novel neural markers of a stuttering “state” in persistent DS, helping to define more focused treatments (e.g. neuro-modulation).
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Affiliation(s)
- Pierpaolo Busan
- IRCCS Fondazione Ospedale San Camillo, Venice, Italy
- * E-mail:
| | - Giovanni Del Ben
- B.R.A.I.N. Center for Neuroscience, Department of Life Sciences, University of Trieste, Trieste, Italy
| | | | - Giulia Natarelli
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
| | - Marco Bencich
- B.R.A.I.N. Center for Neuroscience, Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Fabrizio Monti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Paolo Manganotti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Piero Paolo Battaglini
- B.R.A.I.N. Center for Neuroscience, Department of Life Sciences, University of Trieste, Trieste, Italy
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Vanhoutte S, Santens P, Cosyns M, van Mierlo P, Batens K, Corthals P, De Letter M, Van Borsel J. Increased motor preparation activity during fluent single word production in DS: A correlate for stuttering frequency and severity. Neuropsychologia 2015; 75:1-10. [PMID: 26004061 DOI: 10.1016/j.neuropsychologia.2015.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
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22
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Sinha P, Vandana VP, Lewis NV, Jayaram M, Enderby P. Evaluating the effect of risperidone on speech: A cross-sectional study. Asian J Psychiatr 2015; 15:51-5. [PMID: 26013669 DOI: 10.1016/j.ajp.2015.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 04/09/2015] [Accepted: 05/03/2015] [Indexed: 10/23/2022]
Abstract
Speech subsystems are susceptible to the effects of several factors including medications. The atypical antipsychotics can also adversely affect the speech because of its action on serotonin and dopamine neurotransmitters. The present study aims to analyze the speech characteristics associated with atypical antipsychotic risperidone. Speech of 92 patients on risperidone with or without trihexyphenidyl and/or clonazepam were compared with that of 31 persons who were not on any psychotropic medicines. Compared to control group, maximum phonation duration, sequential motion rate of diadochokinesia was reduced by about 3s and 1syllable/s respectively and s/z ratio was increased by 0.16 in patients with risperidone. Performance of larynx, lips and tongue sub-system and intelligibility of speech were also significantly reduced in risperidone group. Risperidone did impact the phonation and articulation sub-systems of speech mildly, which was independent of tardive dyskinesia and extrapyramidal symptoms. Randomized controlled prospective study looking into impact on speech and related effect on drug adherence, functioning and quality of life needs to be conducted with risperidone and other atypical antipsychotics.
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Affiliation(s)
- Preeti Sinha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India.
| | - V P Vandana
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India.
| | - Nikita Vincent Lewis
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India.
| | - M Jayaram
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India.
| | - Pamela Enderby
- The Innovation Centre, 217 Portobello, Sheffield S1 4DP, UK.
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Selçuk EB, Erbay LG, Özcan ÖÖ, Kartalci Ş, Batcioğlu K. Testosterone levels of children with a diagnosis of developmental stuttering. Ther Clin Risk Manag 2015; 11:793-8. [PMID: 25999727 PMCID: PMC4437599 DOI: 10.2147/tcrm.s83129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Stuttering is defined as a disruption in the rhythm of speech and language articulation, where the subject knows what he/she wants to say, but is unable to utter the intended word or phrase fluently. The effect of sex on development and chronicity of stuttering is well known; it is more common and chronic in males. We aimed to investigate the relationship between developmental stuttering and serum testosterone levels in this study. MATERIALS AND METHODS In this study, we evaluated a total of 50 children (7-12 years of age); eight (16%) were female and 42 (84%) were male. Twenty-five children who stutter and 25 typically fluent peers with the same demographic properties (ages between 7 years and 12 years) were included in this study. The testosterone levels of the two groups were determined in terms of nanogram per milliliter (ng/mL) by enzyme-linked immunosorbent assay. The difference between the means of the two groups was analyzed. RESULTS The medians of the testosterone levels of the stutterer and control groups were determined as 20 ng/mL (range =12-184 ng/mL) and 5 ng/mL (range =2-30 ng/mL), respectively. Testosterone levels of the stutterer group were significantly higher than in the control group (P=0.001). Besides, there was a significant correlation between the severity of the stuttering and testosterone levels in the stutterer group (P=0.0001). CONCLUSION The findings of this study show that testosterone may have an effect on the severity of developmental stuttering and on the clinical differences between sexes. However, further investigations are needed to show that testosterone may play a role in the etiology of developmental stuttering.
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Affiliation(s)
- Engin Burak Selçuk
- Department of Family Medicine, Inonu University Medical Faculty, Malatya, Turkey
| | - Lale Gönenir Erbay
- Department of Psychiatry, Inonu University Medical Faculty, Malatya, Turkey
| | - Özlem Özel Özcan
- Department of Child and Adolescent Psychiatry, Inonu University Medical Faculty, Malatya, Turkey
| | - Şükrü Kartalci
- Department of Psychiatry, Inonu University Medical Faculty, Malatya, Turkey
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Craig-McQuaide A, Akram H, Zrinzo L, Tripoliti E. A review of brain circuitries involved in stuttering. Front Hum Neurosci 2014; 8:884. [PMID: 25452719 PMCID: PMC4233907 DOI: 10.3389/fnhum.2014.00884] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/14/2014] [Indexed: 11/13/2022] Open
Abstract
Stuttering has been the subject of much research, nevertheless its etiology remains incompletely understood. This article presents a critical review of the literature on stuttering, with particular reference to the role of the basal ganglia (BG). Neuroimaging and lesion studies of developmental and acquired stuttering, as well as pharmacological and genetic studies are discussed. Evidence of structural and functional changes in the BG in those who stutter indicates that this motor speech disorder is due, at least in part, to abnormal BG cues for the initiation and termination of articulatory movements. Studies discussed provide evidence of a dysfunctional hyperdopaminergic state of the thalamocortical pathways underlying speech motor control in stuttering. Evidence that stuttering can improve, worsen or recur following deep brain stimulation for other indications is presented in order to emphasize the role of BG in stuttering. Further research is needed to fully elucidate the pathophysiology of this speech disorder, which is associated with significant social isolation.
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Affiliation(s)
| | - Harith Akram
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London London, UK ; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery London, UK
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London London, UK ; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery London, UK
| | - Elina Tripoliti
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London London, UK ; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery London, UK
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Generali JA, Cada DJ. Risperidone: Stuttering. Hosp Pharm 2014; 49:242-3. [DOI: 10.1310/hpj4903-242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu .
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Affiliation(s)
- Joyce A. Generali
- Hospital Pharmacy, Emeritus, Department of Pharmacy Practice, University of Kansas, School of Pharmacy, Kansas City/Lawrence, Kansas
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Zhang S, Li P, Zhang Z, Wang W. Anterior capsulotomy improves persistent developmental stuttering with a psychiatric disorder: a case report and literature review. Neuropsychiatr Dis Treat 2014; 10:553-8. [PMID: 24729709 PMCID: PMC3979796 DOI: 10.2147/ndt.s58984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Stuttering is characterized by disrupted fluency of verbal expression, and occurs mostly in children. Persistent developmental stuttering (PDS) may occur in adults. Reports of the surgical management of PDS are limited. Here we present the case of a 28-year-old man who had had PDS since the age of 7 years, was diagnosed with depression and anxiety disorder at the age of 24 years, and had physical concomitants. He underwent a bilateral anterior capsulotomy 4 years after the diagnosis. Over one year of follow-up, his physical concomitants resolved, and significant improvements in his psychiatric disorders and PDS were observed. To the best of our knowledge, this is the first report of simultaneous improvement in a patient's PDS and psychiatric disorder after a bilateral anterior capsulotomy.
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Affiliation(s)
- Shizhen Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Peng Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Zhujun Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Wei Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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Abstract
Affecting 1% of the general population, stuttering impairs the normally effortless process of speech production, which requires precise coordination of sequential movement occurring among the articulatory, respiratory, and resonance systems, all within millisecond time scales. Those afflicted experience frequent disfluencies during ongoing speech, often leading to negative psychosocial consequences. The aetiology of stuttering remains unclear; compared to other neurodevelopmental disorders, few studies to date have examined the neural bases of childhood stuttering. Here we report, for the first time, results from functional (resting state functional magnetic resonance imaging) and structural connectivity analyses (probabilistic tractography) of multimodal neuroimaging data examining neural networks in children who stutter. We examined how synchronized brain activity occurring among brain areas associated with speech production, and white matter tracts that interconnect them, differ in young children who stutter (aged 3-9 years) compared with age-matched peers. Results showed that children who stutter have attenuated connectivity in neural networks that support timing of self-paced movement control. The results suggest that auditory-motor and basal ganglia-thalamocortical networks develop differently in stuttering children, which may in turn affect speech planning and execution processes needed to achieve fluent speech motor control. These results provide important initial evidence of neurological differences in the early phases of symptom onset in children who stutter.
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Affiliation(s)
- Soo-Eun Chang
- 1 Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA
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Abstract
OBJECTIVE Stuttering is a frequent side effect of many psychotropic drugs, particularly antidepressants. METHOD This is a case report of a woman presenting with stuttering after starting bupropion treatment for her depression. RESULTS The patient's stuttering resolved after discontinuing the bupropion. CONCLUSION Neuroimaging and pharmacological studies have implicated dopamine in the pathophysiology of stuttering. Bupropion's ability to increase dopamine in the frontal cortex was suspected to have been involved in this patient's stuttering. However, further research is needed before causality can be assured.
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Foundas AL, Cindass R, Mock JR, Corey DM. ATYPICAL CAUDATE ANATOMY IN CHILDREN WHO STUTTER 1, 2. Percept Mot Skills 2013. [DOI: 10.2466/15.10.pms.116.2a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Foundas AL, Cindass R, Mock JR, Corey DM. Atypical Caudate Anatomy in Children Who Stutter. Percept Mot Skills 2013; 116:528-43. [PMID: 24032328 DOI: 10.2466/15.10.pms.116.2.528-543] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A temporal motor defect in speech preparation and/or planning may contribute to the development of stuttering. This defect may be linked to a dysfunctional cortical-subcortical network at the level of the striatum. To determine whether structural differences exist and whether group differences are associated with stuttering severity or manual laterality, the caudate was measured in 14 children who stutter (CWS) and in a control group of right-handed boys, ages 8–13 years. There was a statistically significant hemisphere by group effect for caudate volume. CWS had reduced right caudate volume and atypical leftward asymmetry compared to controls. Nine of the 13 CWS with atypical caudate asymmetry had atypical manual laterality. These anomalies may represent a vulnerability that perturbs speech planning/preparation and contributes to inefficiencies in action-perception coupling that may be an indicator of stuttering susceptibility. These results suggest that right-handed boys who stutter may have a defect in the feedforward cortico-striato-thalamo-cortical networks.
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Affiliation(s)
- Anne L. Foundas
- Brain and Behavior Program at Children's, Hospital and Department of Neurology and Cognitive, Neuroscience University of Missouri - Kansas City
| | - Renford Cindass
- Brain and Behavior Program at Children's Hospital, LSU Health Sciences Center
| | - Jeffrey R. Mock
- Brain and Behavior Program at Children's Hospital, Department of Psychology Tulane University
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Busan P, D'Ausilio A, Borelli M, Monti F, Pelamatti G, Pizzolato G, Fadiga L. Motor excitability evaluation in developmental stuttering: A transcranial magnetic stimulation study. Cortex 2013; 49:781-92. [DOI: 10.1016/j.cortex.2011.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 07/15/2011] [Accepted: 12/07/2011] [Indexed: 11/16/2022]
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Rocha FFD. [Aripiprazole-induced stuttering treated with risperidone]. BRAZILIAN JOURNAL OF PSYCHIATRY 2011; 31:388. [PMID: 20098832 DOI: 10.1590/s1516-44462009000400018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Xiong T, Bunning K, Horton S, Hartley S. Assessing and comparing the outcome measures for the rehabilitation of adults with communication disorders in randomised controlled trials: an International Classification of Functioning, Disability and Health approach. Disabil Rehabil 2011; 33:2272-90. [DOI: 10.3109/09638288.2011.568666] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Risperidone reduces tic-like motor behaviors and linguistic dysfluencies in severe persistent developmental stuttering. J Clin Psychopharmacol 2011; 31:131-4. [PMID: 21192161 DOI: 10.1097/jcp.0b013e318205694f] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yadav DS. Risperidone induced stuttering. Gen Hosp Psychiatry 2010; 32:559.e9-10. [PMID: 20851282 DOI: 10.1016/j.genhosppsych.2010.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 12/28/2009] [Accepted: 01/05/2010] [Indexed: 11/29/2022]
Abstract
Stuttering as a side effect of antipsychotics is rare. There are a few case reports of antipsychotic-induced stuttering, namely, chlorpromazine, levomepromazine, trifluoperazine, fluphenazine, olanzapine and clozapine. Risperidone is commonly used as an atypical antipsychotic. It is licensed for both acute and chronic psychosis and mania. There is only one documented case report mentioned on risperidone induced stuttering. One case report of risperidone-induced stuttering is now described. Stuttering is a rare side effect and requires a high index of suspicion for diagnosis. Further study and research to identify the neurophysiological and psychological processes behind adult onset stuttering and identification of the processes involved in risperidone induced stuttering would help our understanding further.
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Affiliation(s)
- Devender Singh Yadav
- Department of Psychiatry, ABU University Local Health Board, Coity Clinic, P.O.W. Hospital, Bridgend, Wales CF31 1RQ, UK.
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Abstract
Stuttering is a vocal phenomenon, which manifests itself as disturbances in speech fluency. While stuttering is most commonly treated with speech therapy and psychotherapy, a number of antipsychotic agents have been investigated as possible treatments. We present the case of a 37-year-old man who developed a post-concussive syndrome with psychosis and associated stuttering after his second exposure to a blast from an improvised explosive device (IED). After treatment with olanzapine, both his psychosis and his stuttering showed significant improvement. We also discuss stuttering and review previous studies that have investigated antipsychotic use in stuttering.
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Abstract
OBJECTIVES Paroxetine has been reported to be useful for management of stuttering symptoms, but only a few reports have examined its effects. We have investigated the efficacy of paroxetine in a randomized, placebo-controlled study. METHODS Five stuttering subjects received paroxetine at 20 mg once daily at night for 12 weeks, and 5 received placebo. The percentages of stuttered words and stuttering-associated movements during speech were measured at baseline and after 6 and 12 weeks of treatment. Moreover, left primary motor cortex excitability was measured using transcranial magnetic stimulation. Specifically, resting and active motor thresholds and the cortical silent period (CSP) were obtained at the same periods in both groups. RESULTS Paroxetine did not affect the percentage of stuttered words between groups. Stuttering-associated movements, however, during speech in facial muscular districts were significantly reduced in subjects treated with paroxetine. Finally, paroxetine administration shortened the CSP with no effect on motor thresholds. CONCLUSION Paroxetine may be useful in qualitative management of stuttering symptoms and may act on the stuttering brain by diminution of intracortical inhibition, as revealed by the shortening of the CSP after paroxetine administration.
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Association between dopaminergic genes (SLC6A3 and DRD2) and stuttering among Han Chinese. J Hum Genet 2009; 54:457-60. [PMID: 19590515 DOI: 10.1038/jhg.2009.60] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Normal function of the dopaminergic system is necessary for speech fluency. There was evidence that the activities of dopamine transporter (DAT) and dopamine D2 receptor (DRD2) could be altered in people with speech disfluency. This study aims to ascertain the possible correlation between two dopaminergic genes (SLC6A3 and DRD2) and disorder of speech fluency, and to determine the allelic frequencies of the five single-nucleotide polymorphisms (SNPs) (rs2617604, rs28364997, rs28364998 in SLC6A3 and rs6275, rs6277 in DRD2) among Han Chinese patients with this disorder. A sample of 112 patients with speech disfluency and 112 gender-matched controls were included in this case-control study. The results show that the presence of C allele at rs6277 in DRD2 gene is associated with increased susceptibility to the disorder, whereas T allele is protective. Haplotype 939T/957T is also a protective factor.
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Chang SE, Kenney MK, Loucks TMJ, Ludlow CL. Brain activation abnormalities during speech and non-speech in stuttering speakers. Neuroimage 2009; 46:201-12. [PMID: 19401143 DOI: 10.1016/j.neuroimage.2009.01.066] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 01/28/2009] [Accepted: 01/30/2009] [Indexed: 10/21/2022] Open
Abstract
Although stuttering is regarded as a speech-specific disorder, there is a growing body of evidence suggesting that subtle abnormalities in the motor planning and execution of non-speech gestures exist in stuttering individuals. We hypothesized that people who stutter (PWS) would differ from fluent controls in their neural responses during motor planning and execution of both speech and non-speech gestures that had auditory targets. Using fMRI with sparse sampling, separate BOLD responses were measured for perception, planning, and fluent production of speech and non-speech vocal tract gestures. During both speech and non-speech perception and planning, PWS had less activation in the frontal and temporoparietal regions relative to controls. During speech and non-speech production, PWS had less activation than the controls in the left superior temporal gyrus (STG) and the left pre-motor areas (BA 6) but greater activation in the right STG, bilateral Heschl's gyrus (HG), insula, putamen, and precentral motor regions (BA 4). Differences in brain activation patterns between PWS and controls were greatest in females and less apparent in males. In conclusion, similar differences in PWS from the controls were found during speech and non-speech; during perception and planning they had reduced activation while during production they had increased activity in the auditory area on the right and decreased activation in the left sensorimotor regions. These results demonstrated that neural activation differences in PWS are not speech-specific.
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Affiliation(s)
- Soo-Eun Chang
- Laryngeal and Speech Section, Medical Neurology Branch, NINDS/NIH, 10 Center Dr. MSC 1416 Building 10, Room 5D38, Bethesda, MD 20892, USA
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Stuart A, Frazier CL, Kalinowski J, Vos PW. The effect of frequency altered feedback on stuttering duration and type. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2008; 51:889-897. [PMID: 18658059 DOI: 10.1044/1092-4388(2008/065)] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE The effect of frequency altered feedback (FAF) on stuttering type (i.e., prolongation, repetition, or silent block) and stuttering duration (i.e., average duration of stuttering event and total stuttering time) was examined. METHOD Retrospective analyses of previously collected data from 12 adult persons who stutter who participated in an ABA time-series design while reading orally was undertaken. It was hypothesized that stuttering duration would decrease and there would be a differential reduction in the type of stuttering during FAF, concurrent with previously confirmed reduction of stuttering episodes. A total of 2,971 stuttered syllables were analyzed. RESULTS The total stuttering duration (s/min) was significantly reduced by approximately 50% irrespective of stuttering type (p = .0014). Although significant differences in the average duration(s) of the 3 stuttering types (p = .0064) existed, FAF significantly reduced each type of stuttering by approximately 20% (p = .0055). There was no differential effect on the reduction of proportion of stuttering type during FAF (p = .36). CONCLUSIONS FAF positively affects the speech of persons who stutter by reducing the proportion of stuttered events with a concomitant decrease in duration of residual stuttering and total stuttering time during oral reading.
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Affiliation(s)
- Andrew Stuart
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC 27858-4353, USA.
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Watkins KE, Smith SM, Davis S, Howell P. Structural and functional abnormalities of the motor system in developmental stuttering. Brain 2008; 131:50-9. [PMID: 17928317 PMCID: PMC2492392 DOI: 10.1093/brain/awm241] [Citation(s) in RCA: 245] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Though stuttering is manifest in its motor characteristics, the cause of stuttering may not relate purely to impairments in the motor system as stuttering frequency is increased by linguistic factors, such as syntactic complexity and length of utterance, and decreased by changes in perception, such as masking or altering auditory feedback. Using functional and diffusion imaging, we examined brain structure and function in the motor and language areas in a group of young people who stutter. During speech production, irrespective of fluency or auditory feedback, the people who stuttered showed overactivity relative to controls in the anterior insula, cerebellum and midbrain bilaterally and underactivity in the ventral premotor, Rolandic opercular and sensorimotor cortex bilaterally and Heschl's gyrus on the left. These results are consistent with a recent meta-analysis of functional imaging studies in developmental stuttering. Two additional findings emerged from our study. First, we found overactivity in the midbrain, which was at the level of the substantia nigra and extended to the pedunculopontine nucleus, red nucleus and subthalamic nucleus. This overactivity is consistent with suggestions in previous studies of abnormal function of the basal ganglia or excessive dopamine in people who stutter. Second, we found underactivity of the cortical motor and premotor areas associated with articulation and speech production. Analysis of the diffusion data revealed that the integrity of the white matter underlying the underactive areas in ventral premotor cortex was reduced in people who stutter. The white matter tracts in this area via connections with posterior superior temporal and inferior parietal cortex provide a substrate for the integration of articulatory planning and sensory feedback, and via connections with primary motor cortex, a substrate for execution of articulatory movements. Our data support the conclusion that stuttering is a disorder related primarily to disruption in the cortical and subcortical neural systems supporting the selection, initiation and execution of motor sequences necessary for fluent speech production.
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Affiliation(s)
- Kate E Watkins
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
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Smits-Bandstra S, De Nil LF. Sequence skill learning in persons who stutter: implications for cortico-striato-thalamo-cortical dysfunction. JOURNAL OF FLUENCY DISORDERS 2007; 32:251-278. [PMID: 17963936 DOI: 10.1016/j.jfludis.2007.06.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 05/29/2007] [Accepted: 06/07/2007] [Indexed: 05/25/2023]
Abstract
UNLABELLED The basal ganglia and cortico-striato-thalamo-cortical connections are known to play a critical role in sequence skill learning and increasing automaticity over practice. The current paper reviews four studies comparing the sequence skill learning and the transition to automaticity of persons who stutter (PWS) and fluent speakers (PNS) over practice. Studies One and Two found PWS to have poor finger tap sequencing skill and nonsense syllable sequencing skill after practice, and on retention and transfer tests relative to PNS. Studies Three and Four found PWS to be significantly less accurate and/or significantly slower after practice on dual tasks requiring concurrent sequencing and colour recognition over practice relative to PNS. Evidence of PWS' deficits in sequence skill learning and automaticity development support the hypothesis that dysfunction in cortico-striato-thalamo-cortical connections may be one etiological component in the development and maintenance of stuttering. EDUCATIONAL OBJECTIVES As a result of this activity, the reader will: (1) be able to articulate the research regarding the basal ganglia system relating to sequence skill learning; (2) be able to summarize the research on stuttering with indications of sequence skill learning deficits; and (3) be able to discuss basal ganglia mechanisms with relevance for theory of stuttering.
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Affiliation(s)
- Sarah Smits-Bandstra
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada.
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Duong PH, Zulian GB. Disappearance of a stutter shortly before death. Am J Hosp Palliat Care 2007; 24:141-3. [PMID: 17502440 DOI: 10.1177/1049909106295296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A patient with a stutter caused by the trauma of the death of a loved one was able to recover normal speech 1 week before her death, which resulted from intestinal obstruction caused by ovarian cancer. The stutter appeared to have been overcome using a combination therapy of sophrology, self-regulation, and drug therapy. During a genuine resilience process, the patient was able to overcome an earlier existential fracture. In this final phase of life, health professionals and the family fully respected the patient's independence to remain in control of events. She repeatedly refused to have a nasogastric tube inserted to extract fecal matter from the stomach. This patient consequently repossessed her own language of expression in a body that was shattered by cancerous illness and the consequences of treatments. She thus managed to find a successful balance between the body, the spirit, and the brain.
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Affiliation(s)
- Phuc H Duong
- CESCO (Centre of Continuous Care), Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, 11, Collonge-Bellerive, Switzerland
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Bothe AK, Davidow JH, Bramlett RE, Franic DM, Ingham RJ. Stuttering treatment research 1970-2005: II. Systematic review incorporating trial quality assessment of pharmacological approaches. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2006; 15:342-52. [PMID: 17102145 DOI: 10.1044/1058-0360(2006/032)] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE To complete a systematic review, incorporating trial quality assessment, of published research about pharmacological treatments for stuttering. Goals included the identification of treatment recommendations and research needs based on the available high-quality evidence. METHOD Multiple readers reviewed 31 articles published between 1970 and 2005, using a written data extraction instrument developed as a synthesis of existing standards and recommendations. Articles were then assessed using 5 methodological criteria and 4 outcomes criteria, also developed from previously published recommendations. RESULTS None of the 31 articles met more than 3 of the 5 methodological criteria (M = 1.74). Four articles provided data to support a claim of short-term improvement in social, emotional, or cognitive variables. One article provided data to show that stuttering frequency was reduced to less than 5%, and 4 additional articles provided data to show that stuttering may have been reduced by at least half. Among the articles that met the trial quality inclusion criterion for the second stage of this review, none provided uncomplicated positive reports. CONCLUSIONS None of the pharmacological agents tested for stuttering have been shown in methodologically sound reports to improve stuttering frequency to below 5%, to reduce stuttering by at least half, or to improve relevant social, emotional, or cognitive variables. These findings raise questions about the logic supporting the continued use of current pharmacological agents for stuttering.
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Affiliation(s)
- Anne K Bothe
- Department of Communication Sciences and Special Education, The University of Georgia, Athens, GA 30602, USA.
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Abstract
Atypical antipsychotic drugs are primarily indicated for the treatment of psychotic disorders such as schizophrenia and schizoaffective disorder. Recently, they have also been used for mood stabilization. This article reviews other, potentially therapeutically useful indications for these medications. In most cases, the evidence supporting these new uses is limited but provocative, and involves only case reports. It has not yet been determined whether the usefulness of atypical antipsychotics for nonpsychotic disorders outweighs their potential to cause serious side effects.
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Affiliation(s)
- Nora Selengut Brooke
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Maguire GA, Yu BP, Franklin DL, Riley GD. Alleviating stuttering with pharmacological interventions. Expert Opin Pharmacother 2005; 5:1565-71. [PMID: 15212606 DOI: 10.1517/14656566.5.7.1565] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Stuttering is a speech disorder characterised by frequent prolongations, repetitions or blocks of spoken sounds and/or syllables. Stuttering is very common and is classified by the Diagnostic and Statistical Manual of Mental Disorders -- Fourth Edition (DSM-IV) as an Axis I disorder. In spite of this, stuttering treatment is sporadically addressed by a practicing physician, especially in the US. Much has recently been learned of the neurophysiological basis of this disorder, which has provided insight into novel treatment strategies, thus helping to guide the practising clinician. Stuttering is likely to be associated, at least in part, to dopamine hyperactivity in the brain. Novel dopamine antagonists such as risperidone and olanzapine, have recently been shown to improve the symptoms of stuttering providing a strong foundation for physicians to more effectively treat this disorder.
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Affiliation(s)
- Gerald A Maguire
- University of California, Department of Psychiatry, Route 88, 101 The City Drive South, Irvine Medical Centre, Orange, CA 92868, USA
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Stager SV, Calis K, Grothe D, Bloch M, Berensen NM, Smith PJ, Braun A. Treatment with medications affecting dopaminergic and serotonergic mechanisms: effects on fluency and anxiety in persons who stutter. JOURNAL OF FLUENCY DISORDERS 2005; 30:319-35. [PMID: 16246409 DOI: 10.1016/j.jfludis.2005.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Revised: 09/07/2005] [Accepted: 09/16/2005] [Indexed: 05/05/2023]
Abstract
UNLABELLED Medications with dopamine antagonist properties, such as haloperidol, and those with serotonin reuptake inhibitor properties, such as clomipramine, have been shown to improve fluency. To examine the degree to which each of these two pharmacological mechanisms might independently affect fluency, a selective serotonin reuptake inhibitor, paroxetine, and a selective dopamine (D-2) antagonist, pimozide, were evaluated. Both types of medications also affect mood and anxiety, factors that could influence fluency levels. Therefore, we also evaluated the medications' effects on generalized and speech-related anxiety and the relationships between changes in anxiety and changes in fluency in 11 subjects with a history of developmental stuttering. The randomized, double blind, placebo-controlled crossover study that was designed had to be terminated prior to completion due to severe side effects following withdrawal from paroxetine. Even with a reduced sample size (n=6), significant improvement in percent fluent speaking time (p=0.02) was found using a telephone task between baseline and pimozide (n=6), with average duration of dysfluencies significantly shorter (p=0.04) but no significant difference in the estimated number of dysfluencies per minute. This significant improvement was associated with non-significant increases in generalized anxiety, but non-significant decreases in speech-related anxiety. No significant differences were found in fluency between baseline and paroxetine (n=5). These preliminary results suggest that fluency improvement is more likely to be mediated by dopaminergic rather than serotonergic mechanisms. Due to its side effects, however, pimozide may be considered a risk for treatment of stuttering. EDUCATIONAL OBJECTIVES As a result of reading this paper the reader will describe and explain: (1) how medications may affect fluency and the rationale for selecting medications for treatment trials; (2) the interrelationship between fluency and anxiety; and (3) factors important in developing clinical trials using medications.
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Affiliation(s)
- Sheila V Stager
- Voice and Speech Section, NIDCD, Bethesda, MD 20892-1416, USA.
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