below. Typical signs are sudden onset of obsessive- compulsive symptoms, such as excessive fear of germs, problems of eating, excessive anxiety, tics, and unusual movements. Treatment guidelines for PANDAS have been published, regarding treatment of infection (Cooperstock et al., 2017) and inflammation (Frankovich et al., 2017).
In the second paper (Alm, 2021a), it is proposed that stuttering may be related to a reduction of the peak rate of energy supply to neurons, which could affect specific signaling in the brain. The article is a review of a number of disparate observations of stuttering, which are discussed in relation to the hypothesis of limited energy supply. This includes brain imaging data, EEG data, genetic differences related to the lysosomes and a gene called ARNT2, the risk for effects of early hypoxia, the blood level of nitric oxide, and the role of thiamine. It can here be mentioned that Dr. Shahriar SheikhBahaei, at the NIH, independently also has come to focus on the possible role of energy supply in stuttering, investigating the functions of the astrocytes in animal models.
central roles both for the learning and execution of automatized sequences of movements. Furthermore, the release of dopamine is strongly influenced by motivation, emotions, and the mental activity. Possible mechanisms of stuttering are discussed briefly, and it is proposed that variations of dopamine release constitute the main neural mechanism underlying the variations of stuttering between situations. In other words, the normal dopamine system appears to have the properties required to result in the psychological effects that can be observed in stuttering, even though psychology does not seem to be the basic cause of stuttering.
The series of theory articles is planned to continue, including an article attempting to link and integrate the disparate aspects discussed.
Alm (2004). Stuttering and the Basal Ganglia circuits.
J.Commun. Disord. 37, 325–369.
Alm (2020). Streptococcal Infection as a Major Historical Cause of Stuttering.
Front.Hum. Neurosci. 14, 569519.
Alm (2021a). Stuttering: A Disorder of Energy Supply to Neurons?
Front.Hum.Neurosci. 15, 662204.
Alm (2021b). The Dopamine System and Automatization of Movement Sequences.
Front.Hum.Neurosci. 15, 661880.
Cooperstock (2017). Clinical Management of [PANS]: Infections.
J.ChildAdolesc.Psychopharmacol. 27, 594–606.
“It is clear that the complexity of stuttering is such that no single method in itself will be able to capture its nature.” -Dr. Per A. Alm, Ph.D.
Frankovich (2017). Clinical Management of [PANS]: Immunomodulatory Therapies.
J.ChildAdolesc.Psychopharmacol. 27, 574–593.
Constantino (2018). What Can Stutterers Learn from the Neurodiversity Movement? Semin. Speech Lang. 39, 382–396.
Maguire (2010). Stuttering onset associated with streptococcal infection: a case suggesting stuttering as PANDAS.
Ann.Clin. Psychiatry 22, 283–284.
NIH. PANDAS—Questions and Answers.
https://www.nimh.nih.gov/ health/publications/pandas
The third paper (Alm, 2021b), is a general review of the functions of the dopamine system and the mechanisms for automatization of movement sequences. Speech and stuttering are discussed briefly in this context. Speech is probably the most strongly automatized motor behavior in humans, and its mechanisms appears to follow the mechanisms for movements in general. Dopamine is the key substance for the initiation of voluntary movement, within the basal ganglia. It also has
Dr. Per A. Alm currently works at the Department of Neuroscience, Uppsala University, Sweden, and is affiliated with the School of Medicine at the University of California Riverside.
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