| OBJECTIVE: To present patients with stuttering speech in association with stroke. DESIGN: Case series with follow-up for 5 years, or until the stuttering resolved. SETTING: University and community hospital neurology wards, and ambulatory neurology clinics. patients: Four patients who developed stuttering speech in association with an acute ischemic stroke. A 68-year-old man acutely developed stuttering with a large left middle cerebral artery distribution stroke. A 59-year-old man who had stuttered as a child began to stutter 2 months after a left temporal lobe infarction, as nonfluent aphasia was improving. Another childhood stutterer, a 59-year-old originally left-handed man developed severe but transient stuttering with a right parietal infarction. A 55-year-old man with a left occipital infarction had a right hemianopia and an acquired stutter, for which he was anosognosic. CONCLUSION: The clinical presentation of stroke-associated stuttering is variable, as are the locations of the implicated infarctions. ( info) |
2/100. Developmental stuttering and Parkinson's disease: the effects of levodopa treatment. The effects of dopamine on developmental stuttering was studied in a 44 year old man with developmental stuttering and Parkinson's disease during three levodopa "on" periods and three "off" periods. When compared with the "off" periods, during the "on"' periods he demonstrated an increase of speech dysfluencies. These findings lend support to the dopamine hypothesis of developmental stuttering. ( info) |
3/100. Technical solutions for quantitative and qualitative assessments of speech fluency. Current and emerging technical solutions for the differential diagnostic evaluation and assessment of speech fluency are reviewed and discussed. These systems were selected with just one intentional bias--the need for clinicians to carry out valid, reliable, and accurate measurements of speech fluency, its disruptions, and associated clinical features. Some seasoned technical solutions for the assessment and evaluation of stuttering have been known for many years, but have received little attention. Recently, a number of new options have appeared, and others are in the final stage of development. Empirical data about the performance or functionality of all of these technologies are lacking. As a result, clinicians who purchase them do not have access to adequate performance-related data. This article should help clinicians make reasonable judgments about the effectiveness of emerging technologies specific to assessment of speech fluency. ( info) |
4/100. Speaking in the claustrum: the psychodynamics of stuttering. The author outlines the psychoanalytic theory of stuttering and, discussing material from the analysis of a stutterer and its transference and countertransference processes, puts forward a new hypothesis of the psychodynamics of stuttering in conjunction with Meltzer's theory of the claustrum. He argues that the stutterer is working out intolerable experiences of separation from the primary object and a resulting catastrophic experience of the oedipal situation through an unconscious fantasy in which anal qualities are conferred on the internal maternal object by a predominating hatred. The intrusive identification of parts of the self in the maternal rectum gives rise to a claustrophobic experiential world in which all obstacles that are encountered between self and object must be eliminated. The anal-sadistic object space of the claustrum is projected on to the external object space and thus also on to the mouth as the origin of the sound envelope, where it produces both a lifeless sound envelope and a torn content, i.e. stuttered sounds, words and sentences. Correspondingly, a dead speech melody and broken words have their parallels in object relations that are characterised by an attack on linking and by psychic withdrawal. ( info) |
5/100. Clinical technologies for the reduction of stuttering and enhancement of speech fluency. Among the clinical technologies for the treatment of fluency disorders presented in this article are systems for assisting and automating feedback on stuttering severity, establishing speech changes that enhance fluency, and modifying speech-related sensory feedback for fluency enhancement. Some additional technologies, which have been implemented only in research but are expected to find their way to clinicians in the near future, are also discussed. The effectiveness of microcomputer applications for the treatment of stuttering has received little research; however, some answers about their effectiveness may be inferred from descriptions of their operational features and published specifications. ( info) |
6/100. Bilateral globus pallidus lesions in a patient with tourette syndrome and related disorders. BACKGROUND: The neuroanatomic and pathologic basis of Tourette's syndrome or related disorders such as obsessive-compulsive disorder and attention deficit-hyperactivity disorder remains unknown. Although a substantial body of neuroimaging and other data implicate basal ganglia and some point out specifically the globus pallidus in the etiopathogenesis of these three related disorders, no clear or pathologically significant isolated lesions restricted to this region have yet been demonstrated, with the exception of obsessive-compulsive disorder. methods: A seventeen-year-old male case of tourette syndrome with comorbid obsessive-compulsive disorder, attention deficit-hyperactivity disorder, stuttering and gait disturbance, who had negative family history is presented. RESULTS: The patient has failed to respond to drug treatment and his MRI scan revealed bilateral and symmetrical globus pallidus lesions with specific "tiger's eye" appearance of unknown etiology. CONCLUSIONS: Well-localized lesions in the globus pallidus support growing data suggesting the involvement of this brain region in tourette syndrome and related disorders. ( info) |
| Vast arrays of medications have been used, with limited success, to manage stuttering. haloperidol and risperidone are the only two medications that have shown efficacy via double-blind studies in controlling stuttering symptoms. We present the first case reports of olanzapine in the management of stuttering. Three case histories are presented: a 10-year-old boy, a 16-year-old male adolescent with developmental stuttering, and a 9-year-old boy with medication-induced stuttering whose symptoms are successfully controlled with olanzapine. These case studies suggest that olanzapine may be a pharmacologic option in the management of stuttering. ( info) |
8/100. Acquired transient stuttering during a migraine attack. stuttering is an abnormality in the fluency of speech, which is characterized by interruption of the normal rhythm due to involuntary repetition and prolongation, or arrest, of uttered letters or syllables. The aphasic syndrome and dysarthria can be associated with classic migraine, but, to our knowledge, no study has so far described stuttering as the only neurological symptom accompanying an attack. ( info) |
9/100. Hashimoto's encephalopathy. Hashimoto's encephalopathy is a subacute condition associated with autoimmune thyroiditis. Its presentation varies from focal neurologic deficits to global confusion. Unlike encephalopathy associated with hypothyroidism, Hashimoto's encephalopathy responds to steroid therapy and not thyroxine replacement. ( info) |
| The pathophysiology of developmental or acquired stuttering still remains an enigma. In a few cases, the developmental stuttering that had disappeared spontaneously or as a result of therapy reoccurred following a brain lesion. We report on a patient with return of developmental stuttering following a left hemispheric stroke. This case supports the theory that acquired brain lesions may cause a return of stuttering, possibly by interfering with the compensatory mechanism(s) that once had relieved the developmental stuttering. ( info) |