Abstract
Stuttering is a disturbance in normal fluency and time patterning of speech that is inappropriate for the person's age. Stuttering, which appears during childhood but does not undergo spontaneous or speech therapy-induced remission is known as persistent developmental stuttering (PDS). Various factors like incomplete lateralization of abnormal cerebral dominance, genetic factors and overactive pre-synaptic dopamine systems in regions of the brain that modulate verbalization have been implicated in the etiology of stuttering [1]. Here, we present a case of developmental stuttering resistant to speech therapy that remitted with risperidone.
Mr. X, 42-year-old male, a known case of bipolar affective disorder and persistent developmental stuttering presented to our hospital with symptoms of depression. He was given bupropion 450 mg/day along with lamotrigine 200 mg/day. The depressive symptoms disappeared with this regimen but he found a worsening of stuttering. He also reported difficulty in breathing, particularly during talking. The examination of throat, chest and cardiovascular system revealed no abnormality. Suspecting that stuttering and breathing difficulty while talking were part of tic disorder that was worsening with bupropion, the latter was stopped and risperidone 1mg/day was added. The stuttering and breathing difficulty improved dramatically within a month. With increase of risperidone to 2mg/day the problems disappeared completely. The depressive symptoms were treated with escitalopram 10 mg/day given for 2 months. The patient continues to do well on a combination of risperidone and lamotrigine.
Our patient suffered from bipolar affective disorder with persistent developmental stuttering. The patient's stuttering worsened when he was started on bupropion 450 mg/day, a selective dopamine re-uptake inhibitor. Worsening of tics with dopamine-enhancing drugs is expected. Tic movements as part of stuttering have also been well described [2]. In this patient the worsening of stuttering strongly suggested that tic movements of the vocal apparatus and chestmuscles were involved. The improvement of stuttering is thus attributable to the blockage of the hyperdopaminergic state by risperidone, which is an atypical antipsychotic with a potent antidopaminergic property. Another antipsychotic olanzapine has been reported to be efficacious in the treatment of developmental stuttering in children [3]. Recognizing the tic-like movements of the vocal apparatus, especially in patients of stuttering resistant to speech therapy intervention, is helpful in the treatment of long-standing stuttering which may be a part of tic movement of the vocal apparatus.