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 LETTERS TO THE EDITOR

Gabapentin for treating acquired neurogenic stuttering

Gerald Maguire, MD, DFAPA

Department of Psychiatry and Human Behavior, University of California, Irvine School of Medicine, Irvine, CA, USA

Aislinn A. Bird, MD, MPH

Department of Psychiatry and Human Behavior, University of California, Irvine School of Medicine, Irvine, CA, USA

KEYWORDS: neurogenic stuttering, stuttering, gabapentin

ANNALS OF CLINICAL PSYCHIATRY 2012;24(3):240

TO THE EDITOR:

Acquired neurogenic stuttering is a dysfluency in the time patterning of speech, which occurs after a period of normal speech fluency and is caused by damage to the CNS.1 This differs from childhood onset fluency disorder—developmental stuttering—which presents in early childhood and is not caused by a neurologic insult.2 Neurogenic stuttering has been associated with injury to all areas of the brain—except the occipital lobe—and many etiologies including stroke, traumatic brain injury, seizure disorder, encephalitis, Parkinson’s disease, and dementia.3 γ-aminobutyric acid (GABA) modulation also has been postulated in stuttering treatment.4

Case report

Mrs. P, age 33, is a right-handed female with acquired neurogenic stuttering. She was in good health with normal speech fluency when she contracted Guillain-Barré syndrome at age 9, which left her mute for 15 months. She developed a severe stutter after spontaneous recovery of her ability to speak; 9 years of speech therapy did not provide improvement. In 2002, she obtained a delayed auditory feedback (DAF) device, which provided limited improvement in her speech. She presented to our clinic with the desire for pharmacotherapy. We placed her on gabapentin, 300 mg/d, which was titrated to 2,700 mg/d. After 3 weeks, Mrs. P experienced approximately 40% improvement in her fluency, based on the Clinical Global Impressions-Improvement scale, with a decrease in hesitancy and an improvement in speech initiation.5 She also reported a marked increase in stuttering if she missed a dose. She tolerated the medication well, except for mild sedation.

  DISCUSSION

In this case, gabapentin is associated with increased fluency. Our patient experienced benefit from intermittent use of a DAF device, even after 10 years of use. This case suggests that gabapentin and DAF may be well-tolerated treatments for acquired neurogenic stuttering. More research is required, especially in relation to the role of GABA modulation in stuttering.

DISCLOSURES: Dr. Maguire receives grant or research support from Eli Lilly and Company, Endo, Merck, and Otsuka; is a consultant to Eli Lilly and Company, Endo, Merck, and Teva; and is a speaker for Angelini/Labopharm, Eli Lilly and Company, Lundbeck, Merck, Novartis, and Sunovion. Dr. Bird reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

    REFERENCES

  1. Van Borsel J, Taillieu C. Neurogenic stuttering versus developmental stuttering: an observer judgement study. J Commun Disord. 2001;34:385–395.
  2.  American Psychiatric Association Childhood onset fluency disorder. http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=92. Accessed May 3, 2012.
  3. Krishnan G, Tiwari S. Revisiting the acquired neurogenic stuttering in the light of develop-mental stuttering. J Neurolinguistics. 2011;24:383–396.
  4. Maguire G, Franklin D, Vatakis NG, et al. Exploratory randomized clinical study of pagoclone in persistent developmental stuttering: the examining pagoclone for persistent developmental stuttering Study. J Clin Psychopharmacol. 2010;30:48–56.
  5. Guy W. The Clinical Global Impression Scale. In: Guy W, ed. ECDEU assessment manual for psychopharmacology. Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch, Division of Extramural Research Programs; 1976:218-222.

CORRESPONDENCE: Aislinn Bird, MD, MPH, 27855 Moody Road, Los Altos Hills, CA 94022 USA, E-MAIL: aislinnbird@gmail.com