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Pasculli G, Busan P, Jackson ES, Alm PA, De Gregorio D, Maguire GA, Goodwin GM, Gobbi G, Erritzoe D, Carhart-Harris RL. Psychedelics in developmental stuttering to modulate brain functioning: a new therapeutic perspective? Front Hum Neurosci 2024; 18:1402549. [PMID: 38962146 PMCID: PMC11221540 DOI: 10.3389/fnhum.2024.1402549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 05/27/2024] [Indexed: 07/05/2024] Open
Abstract
Developmental stuttering (DS) is a neurodevelopmental speech-motor disorder characterized by symptoms such as blocks, repetitions, and prolongations. Persistent DS often has a significant negative impact on quality of life, and interventions for it have limited efficacy. Herein, we briefly review existing research on the neurophysiological underpinnings of DS -specifically, brain metabolic and default mode/social-cognitive networks (DMN/SCN) anomalies- arguing that psychedelic compounds might be considered and investigated (e.g., in randomized clinical trials) for treatment of DS. The neural background of DS is likely to be heterogeneous, and some contribution from genetically determinants of metabolic deficiencies in the basal ganglia and speech-motor cortical regions are thought to play a role in appearance of DS symptoms, which possibly results in a cascade of events contributing to impairments in speech-motor execution. In persistent DS, the difficulties of speech are often linked to a series of associated aspects such as social anxiety and social avoidance. In this context, the SCN and DMN (also influencing a series of fronto-parietal, somato-motor, and attentional networks) may have a role in worsening dysfluencies. Interestingly, brain metabolism and SCN/DMN connectivity can be modified by psychedelics, which have been shown to improve clinical evidence of some psychiatric conditions (e.g., depression, post-traumatic stress disorder, etc.) associated with psychological constructs such as rumination and social anxiety, which also tend to be present in persistent DS. To date, while there have been no controlled trials on the effects of psychedelics in DS, anecdotal evidence suggests that these agents may have beneficial effects on stuttering and its associated characteristics. We suggest that psychedelics warrant investigation in DS.
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Affiliation(s)
- Giuseppe Pasculli
- Department of Computer, Control, and Management Engineering (DIAG), La Sapienza University, Rome, Italy
- Italian Society of Psychedelic Medicine (Società Italiana di Medicina Psichedelica–SIMePsi), Bari, Italy
| | | | - Eric S. Jackson
- Department of Communicative Sciences and Disorders, New York University, New York, NY, United States
| | - Per A. Alm
- Department of Communicative Sciences and Disorders, New York University, New York, NY, United States
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Danilo De Gregorio
- IRCCS, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Gerald A. Maguire
- School of Medicine, American University of Health Sciences, Signal Hill, CA, United States
- CenExel CIT Research, Riverside, CA, United States
| | - Guy M. Goodwin
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Gabriella Gobbi
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - David Erritzoe
- Department of Medicine, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
| | - Robin L. Carhart-Harris
- Department of Medicine, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
- Psychedelics Division, Neuroscape, University of California, San Francisco, CA, United States
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Franken MC, Oonk LC, Bast BJEG, Bouwen J, De Nil L. Erasmus clinical model of the onset and development of stuttering 2.0. JOURNAL OF FLUENCY DISORDERS 2024; 80:106040. [PMID: 38493582 DOI: 10.1016/j.jfludis.2024.106040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 12/25/2023] [Accepted: 02/11/2024] [Indexed: 03/19/2024]
Abstract
A clinical, evidence-based model to inform clients and their parents about the nature of stuttering is indispensable for the field. In this paper, we propose the Erasmus Clinical Model of Stuttering 2.0 for children who stutter and their parents, and adult clients. It provides an up-to-date, clinical model summary of current insights into the genetic, neurological, motoric, linguistic, sensory, temperamental, psychological and social factors (be it causal, eliciting, or maintaining) related to stuttering. First a review is presented of current insights in these factors, and of six scientific theories or models that have inspired the development of our current clinical model. Following this, we will propose the model, which has proven to be useful in clinical practice. The proposed Erasmus Clinical Model of Stuttering visualizes the onset and course of stuttering, and includes scales for stuttering severity and impact, to be completed by the (parent of) the person who stutters. The pathway of the model towards stuttering onset is based on predisposing and mediating factors. In most children with an onset of stuttering, stuttering is transient, but if stuttering continues, its severity and impact vary widely. The model includes the circle of Engel (1977), which visualizes unique interactions of relevant biological, psychological, and social factors that determine the speaker's experience of stuttering severity and its impact. Discussing these factors and their interaction with an individual client can feed into therapeutic targets. The model is supplemented by a lifeline casus.
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Affiliation(s)
- Marie-Christine Franken
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Leonoor C Oonk
- StotterFonds, Nijkerk, the Netherlands; University of Applied Sciences, Department of Speech-Language Therapy, Utrecht, the Netherlands
| | | | - Jan Bouwen
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Luc De Nil
- Department of Speech-Language Pathology, University of Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Canada.
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Johnson G, Onslow M, Carey B, Jones M, Kefalianos E. Lidcombe Program telehealth treatment for children 6-12 years of age: A Phase II trial. JOURNAL OF FLUENCY DISORDERS 2024; 80:106057. [PMID: 38613876 DOI: 10.1016/j.jfludis.2024.106057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 03/05/2024] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND For children older than 6 years who stutter, there is a gap in clinical research. This is an issue for speech-language pathologists because the tractability of stuttering decreases and the risk of long-term psychological consequences increase with age. PURPOSE To report a Phase II trial of a telehealth version of the Lidcombe Program with school-age children. METHODS Participants were 37 children who stuttered, 6-12 years of age, from Australia, New Zealand, Hong Kong, and Singapore. Parents were trained by video telehealth how to deliver the Lidcombe Program to their child. Primary and secondary outcomes were stuttering severity and psychosocial functioning measured pre-treatment and at 6 months and 12 months after starting treatment. Parents submitted two 10-minute recordings of their child speaking in conversation, and three measures of anxiety, impact of stuttering, and communication attitude. RESULTS Six months after starting treatment, seven children (18.9%) attained Lidcombe Program Stage 2 criteria, 25 children (67.6%) showed a partial response to treatment, and five children (13.5%) showed no response. By 12 months, 12 children (32.4%) had reached Stage 2 criteria. Psychosocial improvements were observed 6 and 12 months after starting treatment. CONCLUSIONS The Lidcombe Program may eliminate or nearly eliminate stuttering for about one third of children 6-12 years of age. Randomized controlled trials with this age group involving the Lidcombe Program are warranted. In the interim, the Lidcombe Program is a clinical option clinicians can implement with this age group to reduce stuttering and its psychosocial impacts.
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Affiliation(s)
- Georgina Johnson
- University of Melbourne, Department of Audiology & Speech Pathology, VIC, Australia.
| | - Mark Onslow
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | - Brenda Carey
- University of Technology Sydney, Australian Stuttering Research Centre, NSW, Australia
| | - Mark Jones
- Bond University, Institute for Evidence-Based Healthcare, QLD, Australia
| | - Elaina Kefalianos
- University of Melbourne, Department of Audiology & Speech Pathology, VIC, Australia; Murdoch Children's Research Institute, Speech and Language Group, VIC, Australia
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Neef NE, Chang SE. Knowns and unknowns about the neurobiology of stuttering. PLoS Biol 2024; 22:e3002492. [PMID: 38386639 PMCID: PMC10883586 DOI: 10.1371/journal.pbio.3002492] [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: 02/24/2024] Open
Abstract
Stuttering occurs in early childhood during a dynamic phase of brain and behavioral development. The latest studies examining children at ages close to this critical developmental period have identified early brain alterations that are most likely linked to stuttering, while spontaneous recovery appears related to increased inter-area connectivity. By contrast, therapy-driven improvement in adults is associated with a functional reorganization within and beyond the speech network. The etiology of stuttering, however, remains enigmatic. This Unsolved Mystery highlights critical questions and points to neuroimaging findings that could inspire future research to uncover how genetics, interacting neural hierarchies, social context, and reward circuitry contribute to the many facets of stuttering.
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Affiliation(s)
- Nicole E. Neef
- Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Communication Disorders, Ewha Womans University, Seoul, Korea
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Adeck A, Millwater M, Bragg C, Zhang R, SheikhBahaei S. Morphological deficits of glial cells in a transgenic mouse model for developmental stuttering. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.04.574051. [PMID: 38260402 PMCID: PMC10802298 DOI: 10.1101/2024.01.04.574051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Vocal production involves intricate neural coordination across various brain regions. Stuttering, a common speech disorder, has genetic underpinnings, including mutations in lysosomal-targeting pathway genes. Using a Gnptab-mutant mouse model linked to stuttering, we examined neuron and glial cell morphology in vocal production circuits. Our findings revealed altered astrocyte and microglia processes in these circuits in Gnptab-mutant mice, while control regions remained unaffected. Our results shed light on the potential role of glial cells in stuttering pathophysiology and highlight their relevance in modulating vocal production behaviors.
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Costa JB, Juste F, Ritto AP, Sassi FC, Andrade CRFD. Analysis of cumulative risk predictors for persistent stuttering: family perception and amount of speech disruptions. Codas 2023; 35:e20220206. [PMID: 37971052 DOI: 10.1590/2317-1782/20232022206pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/29/2022] [Indexed: 11/19/2023] Open
Abstract
PURPOSE To investigate two independent variables considered as two possible predictors of cumulative risk for persistent stuttering: family perception of stuttering and amount of speech disruptions. METHODS Participants were 452 children, aged 3 to 11:11 years, male and female, divided into 4 groups: group 1 (SCG), composed of 158 children who presented a percentage of stuttered speech disruptions ≥ 3% and family complaint of stuttering; group 2 (SWCG), 42 children who presented percentage of stuttered speech disruptions ≥ 3% and without family complaint of stuttering; group 3 (FCG), 94 children who presented percentage of stuttered speech disruptions ≤ 2. 9% with family complaints of stuttering and group 4 (FWCG), 158 children who presented a percentage of stuttered speech disruptions ≤ 2.9 without family complaints of stuttering. RESULTS For the SCG group, there was a significant relationship between family complaints of stuttering and the number of speech disruptions typical of stuttering. In this group, there was a predominance of male children. For the SWCG group, there was no significant relationship between family complaints of stuttering and the number of speech disruptions. For the FCG group, there was no significant relationship between family complaints of stuttering and the number of speech disruptions. For the FWCG group, there was a significant relation between the absence of a family complaint of stuttering and the reduced number of speech disruptions. CONCLUSION The percentage of speech disruptions ≥ 3% is a risk indicator for persistent stuttering. The percentage of speech disruptions ≤ 2.9% associated with syllable and sound repetitions can be a risk indicator for persistent stuttering. Family complaints of syllable and sound repetitions may be a risk indicator for persistent stuttering. Family complaints of stuttering alone should not be considered an indicator of persistent stuttering.
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Affiliation(s)
- Julia Biancalana Costa
- Divisão de Fonoaudiologia, Faculdade de Medicina, Instituto Central, Hospital das Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Fabiola Juste
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Ana Paula Ritto
- Divisão de Fonoaudiologia, Faculdade de Medicina, Instituto Central, Hospital das Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Fernanda Chiarion Sassi
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Claudia Regina Furquim de Andrade
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil
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Miller HE, Garnett EO, Heller Murray ES, Nieto-Castañón A, Tourville JA, Chang SE, Guenther FH. A comparison of structural morphometry in children and adults with persistent developmental stuttering. Brain Commun 2023; 5:fcad301. [PMID: 38025273 PMCID: PMC10653153 DOI: 10.1093/braincomms/fcad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/07/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
This cross-sectional study aimed to differentiate earlier occurring neuroanatomical differences that may reflect core deficits in stuttering versus changes associated with a longer duration of stuttering by analysing structural morphometry in a large sample of children and adults who stutter and age-matched controls. Whole-brain T1-weighted structural scans were obtained from 166 individuals who stutter (74 children, 92 adults; ages 3-58) and 191 controls (92 children, 99 adults; ages 3-53) from eight prior studies in our laboratories. Mean size and gyrification measures were extracted using FreeSurfer software for each cortical region of interest. FreeSurfer software was also used to generate subcortical volumes for regions in the automatic subcortical segmentation. For cortical analyses, separate ANOVA analyses of size (surface area, cortical thickness) and gyrification (local gyrification index) measures were conducted to test for a main effect of diagnosis (stuttering, control) and the interaction of diagnosis-group with age-group (children, adults) across cortical regions. Cortical analyses were first conducted across a set of regions that comprise the speech network and then in a second whole-brain analysis. Next, separate ANOVA analyses of volume were conducted across subcortical regions in each hemisphere. False discovery rate corrections were applied for all analyses. Additionally, we tested for correlations between structural morphometry and stuttering severity. Analyses revealed thinner cortex in children who stutter compared with controls in several key speech-planning regions, with significant correlations between cortical thickness and stuttering severity. These differences in cortical size were not present in adults who stutter, who instead showed reduced gyrification in the right inferior frontal gyrus. Findings suggest that early cortical anomalies in key speech planning regions may be associated with stuttering onset. Persistent stuttering into adulthood may result from network-level dysfunction instead of focal differences in cortical morphometry. Adults who stutter may also have a more heterogeneous neural presentation than children who stutter due to their unique lived experiences.
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Affiliation(s)
- Hilary E Miller
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
| | - Emily O Garnett
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Elizabeth S Heller Murray
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
- Department of Communication Sciences & Disorders, Temple University, Philadelphia, PA 19122, USA
| | - Alfonso Nieto-Castañón
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
| | - Jason A Tourville
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
| | - Soo-Eun Chang
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Communication Disorders, Ewha Womans University, Seoul 03760, Korea
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI 48824, USA
| | - Frank H Guenther
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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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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Chow HM, Garnett EO, Koenraads SPC, Chang SE. Brain developmental trajectories associated with childhood stuttering persistence and recovery. Dev Cogn Neurosci 2023; 60:101224. [PMID: 36863188 PMCID: PMC9986501 DOI: 10.1016/j.dcn.2023.101224] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/11/2023] [Accepted: 02/25/2023] [Indexed: 02/27/2023] Open
Abstract
Stuttering is a neurodevelopmental disorder affecting 5-8 % of preschool-age children, continuing into adulthood in 1 % of the population. The neural mechanisms underlying persistence and recovery from stuttering remain unclear and little information exists on neurodevelopmental anomalies in children who stutter (CWS) during preschool age, when stuttering symptoms typically first emerge. Here we present findings from the largest longitudinal study of childhood stuttering to date, comparing children with persistent stuttering (pCWS) and those who later recovered from stuttering (rCWS) with age-matched fluent peers, to examine the developmental trajectories of both gray matter volume (GMV) and white matter volume (WMV) using voxel-based morphometry. A total of 470 MRI scans were analyzed from 95 CWS (72 pCWS and 23 rCWS) and 95 fluent peers between 3 and 12 years of age. We examined overall group and group by age interactions in GMV and WMV in preschool age (3-5 years old) and school age (6-12 years old) CWS and controls, controlling for sex, IQ, intracranial volume, and socioeconomic status. The results provide broad support for a possible basal ganglia-thalamocortical (BGTC) network deficit starting in the earliest phases of the disorder and point to normalization or compensation of earlier occurring structural changes associated with stuttering recovery.
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Affiliation(s)
- Ho Ming Chow
- University of Delaware, Department of Communication Sciences and Disorders, Newark, DE 19713, USA
| | - Emily O Garnett
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Soo-Eun Chang
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
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Höbler F, Bitan T, Tremblay L, De Nil L. Explicit benefits: Motor sequence acquisition and short-term retention in adults who do and do not stutter. JOURNAL OF FLUENCY DISORDERS 2023; 75:105959. [PMID: 36736073 DOI: 10.1016/j.jfludis.2023.105959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Motor sequencing skills have been found to distinguish individuals who experience developmental stuttering from those who do not stutter, with these differences extending to non-verbal sequencing behaviour. Previous research has focused on measures of reaction time and practice under externally cued conditions to decipher the motor learning abilities of persons who stutter. Without the confounds of extraneous demands and sensorimotor processing, we investigated motor sequence learning under conditions of explicit awareness and focused practice among adults with persistent development stuttering. Across two consecutive practice sessions, 18 adults who stutter (AWS) and 18 adults who do not stutter (ANS) performed the finger-to-thumb opposition sequencing (FOS) task. Both groups demonstrated significant within-session performance improvements, as evidenced by fast on-line learning of finger sequences on day one. Additionally, neither participant group showed deterioration of their learning gains the following day, indicating a relative stabilization of finger sequencing performance during the off-line period. These findings suggest that under explicit and focused conditions, early motor learning gains and their short-term retention do not differ between AWS and ANS. Additional factors influencing motor sequencing performance, such as task complexity and saturation of learning, are also considered. Further research into explicit motor learning and its generalization following extended practice and follow-up in persons who stutter is warranted. The potential benefits of motor practice generalizability among individuals who stutter and its relevance to supporting treatment outcomes are suggested as future areas of investigation.
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Affiliation(s)
- Fiona Höbler
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Rehabilitation Sciences Building, 500 University Avenue, Suite 160, Toronto, ON M5G 1V7, Canada; Department of Speech-Language Pathology, Temerty Faculty of Medicine, University of Toronto, Rehabilitation Sciences Building, 500 University Avenue, Suite 160, Toronto, ON M5G 1V7, Canada.
| | - Tali Bitan
- Department of Speech-Language Pathology, Temerty Faculty of Medicine, University of Toronto, Rehabilitation Sciences Building, 500 University Avenue, Suite 160, Toronto, ON M5G 1V7, Canada; Department of Psychology and IIPDM, University of Haifa, Haifa 3498838, Israel
| | - Luc Tremblay
- Faculty of Kinesiology and Physical Education, University of Toronto, Clara Benson Building, 320 Huron St., Room 231, Toronto, ON M5S 3J7, Canada; KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada
| | - Luc De Nil
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Rehabilitation Sciences Building, 500 University Avenue, Suite 160, Toronto, ON M5G 1V7, Canada; Department of Speech-Language Pathology, Temerty Faculty of Medicine, University of Toronto, Rehabilitation Sciences Building, 500 University Avenue, Suite 160, Toronto, ON M5G 1V7, Canada
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Furlanis G, Busan P, Formaggio E, Menichelli A, Lunardelli A, Ajcevic M, Pesavento V, Manganotti P. Stuttering-Like Dysfluencies as a Consequence of Long COVID-19. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:415-430. [PMID: 36749838 DOI: 10.1044/2022_jslhr-22-00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE We present two patients who developed neurogenic stuttering after long COVID-19 related to SARS-CoV-2 infection. METHODS AND RESULTS Both patients experienced both physical (e.g., fatigue) and cognitive difficulties, which led to impaired function of attention, lexical retrieval, and memory consolidation. Both patients had new-onset stuttering-like speech dysfluencies: Blocks and repetitions were especially evident at the initial part of words and sentences, sometimes accompanied by effortful and associated movements (e.g., facial grimaces and oro-facial movements). Neuropsychological evaluations confirmed the presence of difficulties in cognitive tasks, while neurophysiological evaluations (i.e., electroencephalography) suggested the presence of "slowed" patterns of brain activity. Neurogenic stuttering and cognitive difficulties were evident for 4-5 months after negativization of SARS-CoV-2 nasopharyngeal swab, with gradual improvement and near-to-complete recovery. CONCLUSIONS It is now evident that SARS-CoV-2 infection may significantly involve the central nervous system, also resulting in severe and long-term consequences, even if the precise mechanisms are still unknown. In the present report, long COVID-19 resulted in neurogenic stuttering, as the likely consequence of a "slowed" metabolism of (pre)frontal and sensorimotor brain regions (as suggested by the present and previous clinical evidence). As a consequence, the pathophysiological mechanisms related to the appearance of neurogenic stuttering have been hypothesized, which help to better understand the broader and possible neurological consequences of COVID-19.
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Affiliation(s)
- Giovanni Furlanis
- Clinical Unit of Neurology, University Hospital and Health Services of Trieste, ASUGI, Italy
- Department of Medicine, Surgical and Health Sciences, University of Trieste, Italy
| | | | - Emanuela Formaggio
- Department of Neuroscience, Section of Rehabilitation, University of Padua, Italy
| | - Alina Menichelli
- Neuropsychological Service, Clinical Unit of Rehabilitation, University Hospital and Health Services of Trieste, ASUGI, Italy
| | - Alberta Lunardelli
- Neuropsychological Service, Clinical Unit of Rehabilitation, University Hospital and Health Services of Trieste, ASUGI, Italy
| | - Milos Ajcevic
- Department of Engineering and Architecture, University of Trieste, Italy
| | - Valentina Pesavento
- Neuropsychological Service, Clinical Unit of Rehabilitation, University Hospital and Health Services of Trieste, ASUGI, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, University Hospital and Health Services of Trieste, ASUGI, Italy
- Department of Medicine, Surgical and Health Sciences, University of Trieste, Italy
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Differences in implicit motor learning between adults who do and do not stutter. Neuropsychologia 2022; 174:108342. [PMID: 35931135 DOI: 10.1016/j.neuropsychologia.2022.108342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/20/2022]
Abstract
Implicit learning allows us to acquire complex motor skills through repeated exposure to sensory cues and repetition of motor behaviours, without awareness or effort. Implicit learning is also critical to the incremental fine-tuning of the perceptual-motor system. To understand how implicit learning and associated domain-general learning processes may contribute to motor learning differences in people who stutter, we investigated implicit finger-sequencing skills in adults who do (AWS) and do not stutter (ANS) on an Alternating Serial Reaction Time task. Our results demonstrated that, while all participants showed evidence of significant sequence-specific learning in their speed of performance, male AWS were slower and made fewer sequence-specific learning gains than their ANS counterparts. Although there were no learning gains evident in accuracy of performance, AWS performed the implicit learning task more accurately than ANS, overall. These findings may have implications for sex-based differences in the experience of developmental stuttering, for the successful acquisition of complex motor skills during development by individuals who stutter, and for the updating and automatization of speech motor plans during the therapeutic process.
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Shaw DM, Polikowsky HP, Pruett DG, Chen HH, Petty LE, Viljoen KZ, Beilby JM, Jones RM, Kraft SJ, Below JE. Phenome risk classification enables phenotypic imputation and gene discovery in developmental stuttering. Am J Hum Genet 2021; 108:2271-2283. [PMID: 34861174 PMCID: PMC8715184 DOI: 10.1016/j.ajhg.2021.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022] Open
Abstract
Developmental stuttering is a speech disorder characterized by disruption in the forward movement of speech. This disruption includes part-word and single-syllable repetitions, prolongations, and involuntary tension that blocks syllables and words, and the disorder has a life-time prevalence of 6-12%. Within Vanderbilt's electronic health record (EHR)-linked biorepository (BioVU), only 142 individuals out of 92,762 participants (0.15%) are identified with diagnostic ICD9/10 codes, suggesting a large portion of people who stutter do not have a record of diagnosis within the EHR. To identify individuals affected by stuttering within our EHR, we built a PheCode-driven Gini impurity-based classification and regression tree model, PheML, by using comorbidities enriched in individuals affected by stuttering as predicting features and imputing stuttering status as the outcome variable. Applying PheML in BioVU identified 9,239 genotyped affected individuals (a clinical prevalence of ∼10%) for downstream genetic analysis. Ancestry-stratified GWAS of PheML-imputed affected individuals and matched control individuals identified rs12613255, a variant near CYRIA on chromosome 2 (B = 0.323; p value = 1.31 × 10-8) in European-ancestry analysis and rs7837758 (B = 0.518; p value = 5.07 × 10-8), an intronic variant found within the ZMAT4 gene on chromosome 8, in African-ancestry analysis. Polygenic-risk prediction and concordance analysis in an independent clinically ascertained sample of developmental stuttering cases validate our GWAS findings in PheML-imputed affected and control individuals and demonstrate the clinical relevance of our population-based analysis for stuttering risk.
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Affiliation(s)
- Douglas M Shaw
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Hannah P Polikowsky
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Dillon G Pruett
- Hearing and Speech Sciences, Vanderbilt University, Nashville, TN 37203, USA
| | - Hung-Hsin Chen
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Lauren E Petty
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Kathryn Z Viljoen
- Curtin School of Allied Health, Curtin University, Perth 6845, Australia
| | - Janet M Beilby
- Curtin School of Allied Health, Curtin University, Perth 6845, Australia
| | - Robin M Jones
- Hearing and Speech Sciences, Vanderbilt University, Nashville, TN 37203, USA
| | - Shelly Jo Kraft
- Communication Sciences and Disorders, Wayne State University, Detroit, MI 48202, USA
| | - Jennifer E Below
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN 37203, USA.
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14
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Thompson-Lake DGY, Scerri TS, Block S, Turner SJ, Reilly S, Kefalianos E, Bonthrone AF, Helbig I, Bahlo M, Scheffer IE, Hildebrand MS, Liégeois FJ, Morgan AT. Atypical development of Broca's area in a large family with inherited stuttering. Brain 2021; 145:1177-1188. [PMID: 35296891 PMCID: PMC9724773 DOI: 10.1093/brain/awab364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 01/18/2023] Open
Abstract
Developmental stuttering is a condition of speech dysfluency, characterized by pauses, blocks, prolongations and sound or syllable repetitions. It affects around 1% of the population, with potential detrimental effects on mental health and long-term employment. Accumulating evidence points to a genetic aetiology, yet gene-brain associations remain poorly understood due to a lack of MRI studies in affected families. Here we report the first neuroimaging study of developmental stuttering in a family with autosomal dominant inheritance of persistent stuttering. We studied a four-generation family, 16 family members were included in genotyping analysis. T1-weighted and diffusion-weighted MRI scans were conducted on seven family members (six male; aged 9-63 years) with two age and sex matched controls without stuttering (n = 14). Using Freesurfer, we analysed cortical morphology (cortical thickness, surface area and local gyrification index) and basal ganglia volumes. White matter integrity in key speech and language tracts (i.e. frontal aslant tract and arcuate fasciculus) was also analysed using MRtrix and probabilistic tractography. We identified a significant age by group interaction effect for cortical thickness in the left hemisphere pars opercularis (Broca's area). In affected family members this region failed to follow the typical trajectory of age-related thinning observed in controls. Surface area analysis revealed the middle frontal gyrus region was reduced bilaterally in the family (all cortical morphometry significance levels set at a vertex-wise threshold of P < 0.01, corrected for multiple comparisons). Both the left and right globus pallidus were larger in the family than in the control group (left P = 0.017; right P = 0.037), and a larger right globus pallidus was associated with more severe stuttering (rho = 0.86, P = 0.01). No white matter differences were identified. Genotyping identified novel loci on chromosomes 1 and 4 that map with the stuttering phenotype. Our findings denote disruption within the cortico-basal ganglia-thalamo-cortical network. The lack of typical development of these structures reflects the anatomical basis of the abnormal inhibitory control network between Broca's area and the striatum underpinning stuttering in these individuals. This is the first evidence of a neural phenotype in a family with an autosomal dominantly inherited stuttering.
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Affiliation(s)
| | - Thomas S Scerri
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville 3052, Australia,Department of Medical Biology, University of Melbourne, 1G Royal Parade, Parkville 305, Australia
| | - Susan Block
- Discipline of Speech Pathology, School of Allied Health, Human Services & Sport, La Trobe University, Bundoora 3086, Australia
| | - Samantha J Turner
- Speech and Language, Murdoch Children’s Research Institute, Parkville 3052, Australia
| | - Sheena Reilly
- Speech and Language, Murdoch Children’s Research Institute, Parkville 3052, Australia,Menzies Health Institute Queensland, Griffith University, Southport 4215, Australia
| | - Elaina Kefalianos
- Speech and Language, Murdoch Children’s Research Institute, Parkville 3052, Australia,Department of Audiology and Speech Pathology, University of Melbourne, Parkville 3052, Australia
| | | | - Ingo Helbig
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104USA,The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA 19104USA,Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104USA,Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104USA
| | - Melanie Bahlo
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville 3052, Australia,Department of Medical Biology, University of Melbourne, 1G Royal Parade, Parkville 305, Australia
| | - Ingrid E Scheffer
- Department of Medicine, University of Melbourne, Austin Hospital, Heidelberg 3084, Australia,Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville 3052, Australia,Murdoch Children’s Research Institute, Parkville 3052, Australia,Florey Institute of Neuroscience and Mental Health, Parkville 3052, Australia
| | - Michael S Hildebrand
- Department of Medicine, University of Melbourne, Austin Hospital, Heidelberg 3084, Australia,Murdoch Children’s Research Institute, Parkville 3052, Australia
| | | | - Angela T Morgan
- Correspondence to: Angela T. Morgan Murdoch Children’s Research Institute Parkville 3052, Australia E-mail:
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15
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Chow HM, Li H, Liu S, Frigerio-Domingues C, Drayna D. Neuroanatomical anomalies associated with rare AP4E1 mutations in people who stutter. Brain Commun 2021; 3:fcab266. [PMID: 34859215 PMCID: PMC8633735 DOI: 10.1093/braincomms/fcab266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/23/2021] [Accepted: 09/17/2021] [Indexed: 11/17/2022] Open
Abstract
Developmental stuttering is a common speech disorder with strong genetic underpinnings. Recently, stuttering has been associated with mutations in genes involved in lysosomal enzyme trafficking. However, how these mutations affect the brains of people who stutter remains largely unknown. In this study, we compared grey matter volume and white matter fractional anisotropy between a unique group of seven subjects who stutter and carry the same rare heterozygous AP4E1 coding mutations and seven unrelated controls without such variants. The carriers of the AP4E1 mutations are members of a large Cameroonian family in which the association between AP4E1 and persistent stuttering was previously identified. Compared to controls, mutation carriers showed reduced grey matter volume in the thalamus, visual areas and the posterior cingulate cortex. Moreover, reduced fractional anisotropy was observed in the corpus callosum, consistent with the results of previous neuroimaging studies of people who stutter with unknown genetic backgrounds. Analysis of gene expression data showed that these structural differences appeared at the locations in which expression of AP4E1 is relatively high. Moreover, the pattern of grey matter volume differences was significantly associated with AP4E1 expression across the left supratentorial regions. This spatial congruency further supports the connection between AP4E1 mutations and the observed structural differences.
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Affiliation(s)
- Ho Ming Chow
- Department of Communication Sciences and Disorders, University of Delaware, Newark, DE 19713, USA
- Katzin Diagnostic & Research PET/MR Center, Nemours/Alfred duPont Hospital for Children, Wilmington, DE 19803, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
- Section on Genetics of Communication Disorders, NIDCD/NIH, Bethesda, MD 20892, USA
| | - Hua Li
- Katzin Diagnostic & Research PET/MR Center, Nemours/Alfred duPont Hospital for Children, Wilmington, DE 19803, USA
| | - Siyuan Liu
- Section on Developmental Neurogenomics, NIMH/NIH, Bethesda, MD 20892, USA
| | | | - Dennis Drayna
- Section on Genetics of Communication Disorders, NIDCD/NIH, Bethesda, MD 20892, USA
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16
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Alm PA. Stuttering: A Disorder of Energy Supply to Neurons? Front Hum Neurosci 2021; 15:662204. [PMID: 34630054 PMCID: PMC8496059 DOI: 10.3389/fnhum.2021.662204] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022] Open
Abstract
Stuttering is a disorder characterized by intermittent loss of volitional control of speech movements. This hypothesis and theory article focuses on the proposal that stuttering may be related to an impairment of the energy supply to neurons. Findings from electroencephalography (EEG), brain imaging, genetics, and biochemistry are reviewed: (1) Analyses of the EEG spectra at rest have repeatedly reported reduced power in the beta band, which is compatible with indications of reduced metabolism. (2) Studies of the absolute level of regional cerebral blood flow (rCBF) show conflicting findings, with two studies reporting reduced rCBF in the frontal lobe, and two studies, based on a different method, reporting no group differences. This contradiction has not yet been resolved. (3) The pattern of reduction in the studies reporting reduced rCBF corresponds to the regional pattern of the glycolytic index (GI; Vaishnavi et al., 2010). High regional GI indicates high reliance on non-oxidative metabolism, i.e., glycolysis. (4) Variants of the gene ARNT2 have been associated with stuttering. This gene is primarily expressed in the brain, with a pattern roughly corresponding to the pattern of regional GI. A central function of the ARNT2 protein is to act as one part of a sensor system indicating low levels of oxygen in brain tissue and to activate appropriate responses, including activation of glycolysis. (5) It has been established that genes related to the functions of the lysosomes are implicated in some cases of stuttering. It is possible that these gene variants result in a reduced peak rate of energy supply to neurons. (6) Lastly, there are indications of interactions between the metabolic system and the dopamine system: for example, it is known that acute hypoxia results in an elevated tonic level of dopamine in the synapses. Will mild chronic limitations of energy supply also result in elevated levels of dopamine? The indications of such interaction effects suggest that the metabolic theory of stuttering should be explored in parallel with the exploration of the dopaminergic theory.
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Affiliation(s)
- Per A. Alm
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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17
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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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18
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Boley N, Patil S, Garnett EO, Li H, Chugani DC, Chang SE, Chow HM. Association Between Gray Matter Volume Variations and Energy Utilization in the Brain: Implications for Developmental Stuttering. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2317-2324. [PMID: 33719533 PMCID: PMC8740693 DOI: 10.1044/2020_jslhr-20-00325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/23/2020] [Accepted: 10/02/2020] [Indexed: 06/12/2023]
Abstract
Purpose The biological mechanisms underlying developmental stuttering remain unclear. In a previous investigation, we showed that there is significant spatial correspondence between regional gray matter structural anomalies and the expression of genes linked to energy metabolism. In the current study, we sought to further examine the relationship between structural anomalies in the brain in children with persistent stuttering and brain regional energy metabolism. Method High-resolution structural MRI scans were acquired from 26 persistent stuttering and 44 typically developing children. Voxel-based morphometry was used to quantify the between-group gray matter volume (GMV) differences across the whole brain. Group differences in GMV were then compared with published values for the pattern of glucose metabolism measured via F18 fluorodeoxyglucose uptake in the brains of 29 healthy volunteers using positron emission tomography. Results A significant positive correlation between GMV differences and F18 fluorodeoxyglucose uptake was found in the left hemisphere (ρ = .36, p < .01), where speech-motor and language processing are typically localized. No such correlation was observed in the right hemisphere (ρ = .05, p = .70). Conclusions Corroborating our previous gene expression studies, the results of the current study suggest a potential connection between energy metabolism and stuttering. Brain regions with high energy utilization may be particularly vulnerable to anatomical changes associated with stuttering. Such changes may be further exacerbated when there are sharp increases in brain energy utilization, which coincides with the developmental period of rapid speech/language acquisition and the onset of stuttering during childhood. Supplemental Material https://doi.org/10.23641/asha.14110454.
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Affiliation(s)
- Nathaniel Boley
- The Institute for Biomedical Sciences, School of Medicine and Health Sciences, The George Washington University, Washington, DC
- Katzin Diagnostic & Research PET/MRI Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Sanath Patil
- Katzin Diagnostic & Research PET/MRI Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
- Premedical-Medical Program, Eberly College of Science, The Pennsylvania State University, University Park
| | - Emily O. Garnett
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Hua Li
- Katzin Diagnostic & Research PET/MRI Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Diane C. Chugani
- Department of Communication Sciences and Disorders, College of Health Sciences, University of Delaware, Newark
| | - Soo-Eun Chang
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
- Cognitive Imaging Research Center, Department of Radiology, College of Osteopathic Medicine, Michigan State University, East Lansing
- Department of Communicative Sciences and Disorders, College of Communication Arts and Sciences, Michigan State University, East Lansing
| | - Ho Ming Chow
- Katzin Diagnostic & Research PET/MRI Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
- Department of Communication Sciences and Disorders, College of Health Sciences, University of Delaware, Newark
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