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CMAJ • June 27, 2000; 162 (13)
© 2000 Canadian Medical Association or its licensors

Review
Synthèse

Stuttering: an update for physicians

Daniel Costa and Robert Kroll

Dr. Costa is in private practice. Dr. Kroll is Director, Speech Foundation of Ontario Stuttering Centre, and Assistant Professor, Graduate Department of Speech-Language-Pathology and Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ont.

Abstract

Stuttering is a disturbance in the normal fluency and time patterning of speech. Developmental stuttering (DS), with or without associated psychiatric illness, is the most common form and includes all cases with gradual onset in childhood that are not the result of acquired brain damage. Persistent developmental stuttering (PDS) is DS that has not undergone spontaneous or speech-therapy-induced remission. Organic models of DS focus on incomplete lateralization or abnormal cerebral dominance. There is also evidence that DS has a significant genetic component to its cause. Neuroimaging research data and the effectiveness of dopamine receptor antagonists in DS seem to support the theory of a hyperdopaminergic origin. Speech therapy remains the main treatment for DS; however, antidepressants can be useful in selected cases. Risperidone, a serotonin-dopamine antagonist, has been shown to be more effective than placebo in decreasing the severity of stuttering. The long-term efficacy and safety of serotonin-dopamine antagonists in DS deserve further study.




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