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The mysterious cause of stuttering in the brain

Gerald Maguire has stuttered since childhood, but you might not guess it from talking to him. For the past 25 years, Maguire – a psychiatrist at the University of California, Riverside – has been treating his disorder with antipsychotic medications not officially approved for the condition. Only with careful attention might you discern his occasional stumble on multisyllabic words like “statistically” and “pharmaceutical”.

Maguire has plenty of company – more than 70 million people worldwide, including about three million Americans, stutter. That is, they have difficulty with the starting and timing of speech, resulting in halting and repetition. That number includes approximately 5% of children, many of whom outgrow the condition, and 1% of adults. Their numbers include presidential candidate Joe Bidenactor James Earl Jones and actress Emily Blunt. Though those people and many others, including Maguire, have achieved career success, stuttering can contribute to social anxiety and draw ridicule or discrimination by others.

Maguire has been treating people who stutter, and researching potential treatments, for decades. He receives daily emails from people who want to try medications, join his trials, or even donate their brains to his university when they die. He’s now embarking on a clinical trial of a new medication, ecopipam, that streamlined speech and improved quality of life in a small pilot study in 2019.

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Others, meanwhile, are delving into the root causes of stuttering, which may also point to novel treatments. In the past, many therapists mistakenly attributed stuttering to a number of causes, such as defects of the tongue and voice box, anxiety, trauma or even poor parenting – and some still do. Yet according to J. Scott Yaruss, a speech-language pathologist at Michigan State University in East Lansing, others have long suspected that neurological problems might underlie stuttering. The first data to back up that hunch came in 1991, he says, when researchers reported altered blood flow in the brains of people who stuttered. Over the past two decades, continuing research has made it more apparent that stuttering is all in the brain.

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