The patient was a man in his 60s. In his youth, he suffered from mild stuttering, which healed naturally by speaking slowly. In his 50s, he experienced a left frontoparietal subcortical hemorrhage. His stuttering did not relapse at that time. However, 10 years later, he suffered a right thalamic hemorrhage, after which his stuttering returned. The following year, we attempted treatment using speech rate control, masking method, delayed auditory feedback, and frequency altered feedback, but the stuttering was unchanged. However, after he received low-frequency repetitive transcranial magnetic stimulation (rTMS) to improve movements in his right fingers, his stuttering symptoms during free conversation decreased. We considered why his stuttering had relapsed and then improved with rTMS. It is likely the right thalamic hemorrhage may have resulted in damage to the speech control function in the motor loop, overactivity in the right motor cortex, and breakdown in the coordinated activity between the hemispheres associated with speech, which may have then caused the relapse of the patientʼs stuttering. Low-frequency rTMS has been reported to suppress activity of the uninvolved side while stimulating the involved side. Thus, performing rTMS in the finger exercise region, which is close to the speech control function area on the right side of the brain, may have also suppressed the overactivity of the right motor cortex, with the result that the coordinated activity between the two hemispheres was repaired and the stuttering improved.
View full abstract