Letters
tiel/l. Baltimore. Williams and Wilkins. 1981 4. Cohen MA. Weisman HW: A biopsychosocial approach to AIDS. Psychosomatics 27:245-249. 1986 5. Cohen MAA: A biopsychosocial approach to the human immunodeficiency virus epidemic. Cell Hosp Psychiatr,r
12:98-123.1990
Stuttering After a Dystonic Reaction SIR: Stuttering typically begins in childhood and can persist throughout adult life. Stuttering-like speech that begins in adulthood is unusual, but it does occur in Parkinson's disease,! closed head injury,~ and, rarely, in cases of hysterical conversion reactions. 1 Typical stuttering has not been previously reported to occur as a result of a dystonic reaction.
Case Report Ms. B. is a 39-year-old woman who had no prior history of speech problems. She was prescribed prochlorperazine for the treatment of nausea and. shortly after her first dose. developed an acute dystonic reaction with tongue and laryngeal spasms. The first reaction subsided in 30 minutes. but a second reaction developed 3 hours later after a repeat dose of prochlorperazine. At that time she presented to an emergency room with severe difficulty speaking because of tongue and laryngeal spasms. After the acute dystonia resolved, Ms. B's abnormal speech pattern persisted and. except for its sudden onset. was indistinguishable from typical stuttering. She had pronounced repetitions and prolongations, as well as secondary mannerisms. like facial grimaces. eye blinks, and knee slaps. Except for the speech dystluencies. the neurological exam was negative. Ms. B. was referred for speech therapy after her problem had persisted for 6 weeks. After six weekly sessions of speech therapy involving deep relaxation and speech retraining. her speech returned to normal. except for very slight delays in vocalization in stressful speaking situations. A 6-rnonth follow-up indicated no further speech problems.
The speech disturbance in Ms. B. 's case was clearly initiated by an acute dystonic reaction. The fact that the dysfluency persisted for 3 VOLUME J I • NUMBER 4· FALL 1990
months after the dystonia cleared suggests that psychological processes were involved in its maintenance. Mechanisms involved in the development of Ms. B. 's stuttering may be relevant to our understanding of stuttering in general. We speculate that after the initial dystonic reaction, Ms. B. became very anxious about her speech. This anxiety took the form of what is referred to in other psychophysiological disorders as "spectatoring." She began to "listen to herself' talking and to monitor her speech in a way that disrupted its natural rhythms and coordination. This case supports behavioral spectatoring as an important factor in the maintenance of a dysfluent speech pattern. Greg Mahr. M.D. William Leith. Ph.D. Wayne State University Detroit. Michigan
References I. Helm NA. Butler RB. Benson DF: Acquired stuttering. Neurologl' 2l\: 1159-1165. 1971\
2. Helm-Estabrooks N. Yeo R. Geschwind N. et al: Stuttering: disappearance and reappearance with acquired brain lesions. Neurology 36: I 109-1 I 12. 19l\6 3. Deal JL. DoroJM: Episodic hysterical stuttering..! S!,,'ech Hear Dis(l1'
tiel/l. Baltimore. Williams and Wilkins. 1981 4. Cohen MA. Weisman HW: A biopsychosocial approach to AIDS. Psychosomatics 27:245-249. 1986 5. Cohen MAA: A biopsychosocial approach to the human immunodeficiency virus epidemic. Cell Hosp Psychiatr,r
12:98-123.1990
Stuttering After a Dystonic Reaction SIR: Stuttering typically begins in childhood and can persist throughout adult life. Stuttering-like speech that begins in adulthood is unusual, but it does occur in Parkinson's disease,! closed head injury,~ and, rarely, in cases of hysterical conversion reactions. 1 Typical stuttering has not been previously reported to occur as a result of a dystonic reaction.
Case Report Ms. B. is a 39-year-old woman who had no prior history of speech problems. She was prescribed prochlorperazine for the treatment of nausea and. shortly after her first dose. developed an acute dystonic reaction with tongue and laryngeal spasms. The first reaction subsided in 30 minutes. but a second reaction developed 3 hours later after a repeat dose of prochlorperazine. At that time she presented to an emergency room with severe difficulty speaking because of tongue and laryngeal spasms. After the acute dystonia resolved, Ms. B's abnormal speech pattern persisted and. except for its sudden onset. was indistinguishable from typical stuttering. She had pronounced repetitions and prolongations, as well as secondary mannerisms. like facial grimaces. eye blinks, and knee slaps. Except for the speech dystluencies. the neurological exam was negative. Ms. B. was referred for speech therapy after her problem had persisted for 6 weeks. After six weekly sessions of speech therapy involving deep relaxation and speech retraining. her speech returned to normal. except for very slight delays in vocalization in stressful speaking situations. A 6-rnonth follow-up indicated no further speech problems.
The speech disturbance in Ms. B. 's case was clearly initiated by an acute dystonic reaction. The fact that the dysfluency persisted for 3 VOLUME J I • NUMBER 4· FALL 1990
months after the dystonia cleared suggests that psychological processes were involved in its maintenance. Mechanisms involved in the development of Ms. B. 's stuttering may be relevant to our understanding of stuttering in general. We speculate that after the initial dystonic reaction, Ms. B. became very anxious about her speech. This anxiety took the form of what is referred to in other psychophysiological disorders as "spectatoring." She began to "listen to herself' talking and to monitor her speech in a way that disrupted its natural rhythms and coordination. This case supports behavioral spectatoring as an important factor in the maintenance of a dysfluent speech pattern. Greg Mahr. M.D. William Leith. Ph.D. Wayne State University Detroit. Michigan
References I. Helm NA. Butler RB. Benson DF: Acquired stuttering. Neurologl' 2l\: 1159-1165. 1971\
2. Helm-Estabrooks N. Yeo R. Geschwind N. et al: Stuttering: disappearance and reappearance with acquired brain lesions. Neurology 36: I 109-1 I 12. 19l\6 3. Deal JL. DoroJM: Episodic hysterical stuttering..! S!,,'ech Hear Dis(l1'
