title: Adult onset of stuttering as a presenting sign in a parkinsonian-like syndrome: a case report.
abstract: Stuttering onset in adulthood is rare. With no prior history of stuttering or demonstrable neurological insult, diagnosis is often that of a conversion reaction. Stuttering as the first sign of a parkinsonian-like syndrome in extrapyramidal disease has only been reported once in the previous 30 years (Koller, 1983). The present case study differs from and builds upon the case reports in the literature, and describes a 29-year-old white male who began stuttering purportedly secondary to psychological stress. The fluency evaluation revealed severe stuttering characterized by multiple repetitions and/or blocks, with 20 or more repetitions per word routinely noted during both conversational speech and oral reading. No starters or secondary stuttering characteristics, no specific word fears or avoidances, and no situational fears were exhibited. The subsequent neurological examination found resting tremor in hands and legs, lingual fasciculations, gait imbalance, and numbness and tingling of the hands and feet, all of which were progressive in nature. Rehabilitation initially focused on fluency therapy, but then included psychiatric therapy, and finally medical intervention. Fluency and psychiatric therapies were unsuccessful in eliminating stuttering. Following a diagnosis of parkinsonian-like syndrome, medical intervention with carbidopa-levodopa resulted in dramatic improvement of motor, sensory, and fluency symptoms. It is important to consider extrapyramidal disease as an etiological factor in patients with adult onset of stuttering.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06504, USA.
authors.forename: S B
authors.initials: SB
authors.lastname: Leder
mesh_terms: D000328:Adult; D017668:Age of Onset; D002230:Carbidopa / Q000008:administration & dosage / Q000627:therapeutic use; D003291:Conversion Disorder / Q000175:diagnosis / Q000523:psychology; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005116:Extrapyramidal Tracts / Q000503:physiopathology*; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D010300:Parkinson Disease / Q000175:diagnosis* / Q000188:drug therapy; D013070:Speech Therapy; D013342:Stuttering / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy
chemical_list: D007980:Levodopa; D002230:Carbidopa