Anterior capsulotomy improves persistent developmental stuttering with a psychiatric disorder: a case report and literature review

Figures & data

Figure 1 Lesions in the anterior limb of the internal capsule 3 months after surgery.

Note: Arrows indicate lesions.

Figure 2 Lesions in the anterior limb of the internal capsule 6 months after surgery.

Note: Arrows indicate lesions.

Table 1 Neuropsychological evaluation tests at 6-month follow-up

	BF	OMAS	TMAS	SMAS
HAM-D (24-item)	27	6	7	5
HAM-A	22	4	10	6
MMSE	29	28	29	30
SIMILARITIES	23	20	22	21
BD	31	37	41	38
ILM	3.5	8	8.5	8
DLM	1.5	7	9.5	8.5
IVR	14	14	14	14
DVR	14	14	14	14
WCST-S
Correct	36	34	38	40
Error	12	14	10	8
PE	6	12	4	0
NPE	6	2	6	8
Categories	3	3	3	3

Abbreviations: BF, before surgery; HAM-D, 24-item Hamilton Depression Rating Scale; HAM-A, Hamilton Anxiety Rating Scale; BD, block design; MMSE, Mini-Mental State Examination; ILM, logical memory subtest of the Wechsler Memory Scale carried out immediately; IVR, visual reproduction subtest of the Wechsler Memory Scale carried out immediately; DLM, logical memory subtest of the Wechsler Memory Scale carried out after a 30-minute delay; DVR, visual reproduction subtest of the Wechsler Memory Scale carried out after a 30-minute delay; NPE, nonperseverative errors; WCST-S, Wisconsin Card Sorting Test-Simplified; PE, perseverative errors; OMAS, 1 month after surgery; TMAS, 3 months after surgery; SMAS, 6 months after surgery.

Table 2 Case reports on the treatment of PDS in adults

Reference	Age (years)	Sex	Treatment and dose (mg/day)	Summary of results
Dias et al^Citation3	24	Female	Fluoxetine 20 and Speech therapy	From severe to moderate speech impairment (IS)
Kumar et al^Citation27	22	Male	Fluoxetine 10–20	“Complete disappearance” of stuttering
Mozos-Ansorena et al^Citation28	33	Male	Olanzapine 5	“Significant improvement” in fluency
Maguire et al^Citation29	19	Male	Asenapine 10	75% improvement in fluency (CGI-I) and common side effect of sedation
	20	Male	Asenapine 5	60% improvement in fluency (CGI-I)
	45	Male	Asenapine 5	60% improvement in speech (CGI-I)
Ranjan et al^Citation30	42	Male	Risperidone 1–2	PDS “disappeared completely”
Tavano et al^Citation31	24	Male	Risperidone 0.5	“Significant improvement” in stuttering
Tran et al^Citation32	38	Male	Aripiprazole 5–15	58% reduction in total SSI-3 score
Balamurali et al^Citation7	69	Female	Craniotomy	“Improved dramatically”

Abbreviations: IS, Iowa Scale; CGI-I, Clinical Global Impression of Improvement; PDS, persistent developmental stuttering; SSI-3, Stuttering Severity Instrument 3.

Table 3 Controlled studies on the treatment of PDS in adults

Reference	Patients (n)	Age (years)	Treatment and dose (mg/day)	Follow-up duration	Summary of result
Maguire et al^Citation2	132	18–65	Pagoclone 0.3–0.6	One year	40% reduction in percentage of syllables stuttered (SSI-3, CGI-I), headache was a common adverse event
Maguire et al^Citation33	16	20–74	Risperidone 0.5–2	6 weeks	Risperidone was superior to a placebo in the percent of syllables stuttered, time spent stuttering, overall stuttering severity, and treatment efficacy; it was well tolerated
Menzies et al^Citation34	30	18–66	CBT	One year	CBT significantly and sustainably improved psychological functioning but did not improve fluency

Abbreviations: PDS, persistent developmental stuttering; SSI-3, Stuttering Severity Instrument 3; CGI-I, Clinical Global Impression of Improvement; CBT, cognitive behavioral therapy.

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