Sunday, August 26, 2007

Latest from the Nordic Neuropsychology

I insisted until Per Alm gave me a statement of what happened at the symposium!!

At the Nordic Neuropsychology Conference a 3 hour symposium on stuttering was held. The speakers were Katrin Neumann, Gerald Maguire, Hans-Georg Bosshardt, and Per Alm. (Lutz Jäncke was unfortunately unable to attend.) A general conclusion may be that the understanding of stuttering in relation to the functions of the brain is developing relatively fast for the moment. However, it is also becoming increasingly clear that the issues indeed are very complex, and will require a broad range of research approaches for a long time. One aspect that may be mentioned is the progress in brain imaging, which seem to start to shed light on mechanisms for late recovery of stuttering (in teenagers and adults).
I agree with the complexity part. We have hit the complexity wall. Stuttering is a malfunctioning of a highly complex system of interacting modules. I fear a big obstable is that the majority of researchers are intellectually badly equipped to tackle these challenges: we need brains with multi-disciplinary expertise combined with extraordinary lucid conceptualisation ability, rigorous quantitative thinking and an understanding of the nature of complex systems.


willme said...

(1)Literature review mentioned in August 14 comment is Per Alm not Arp--high speed typing combined with low speed brain, a bad combination.
(2)Trials may be too small and if a subgroup responding positively represents 5% of the trial population, the effect may be washed out by the placebo effect. Drug companies may not be interested in publishing results for small subgroups even if they could tease out the effects since that subgroup may represent too small a part of the market for the drug.
(3)Negative results-->absence of positive results or, equivalently, the confirming of the null hypothesis.
(4)The reluctance of speech therapists to even mention the possibility of drugs may be based on self interest. This is common in the $$$ based medical community of the U.S. Thirty years ago, psychiatrists refused to subscribe drugs, rather preferring the expensive route of "talk therapy." Also, I knew a periodontist a few years ago who became apoplectic when a study came out suggesting that a simple prophylactic procedure applied daily may eliminate the need for an expensive ginginvectomy. More recently, I had experienced great reluctance among several dermatologists to prescribe a topical solution of imiquimod for basal cell carcinoma on the nose. Why? Writing a prescription nets them $50 while surgical incision yields $800 plus another $4000 for a plastic surgeon to remedy the crater on the nose.
(5)My general rule for (prescription)drug experimentation---look at the downside risks and if you find them acceptable try it. This rule may eliminate my trying zyprexa (olanzapine).

willme said...

Lynn's comments on August 14 about her son Alex is an indication of the complexity involved. She said that Alex responded with increased disfluency on Adderall, which is a amphetamine stimulant that blocks reuptake of norepinephrine AND dopamine into the presynaptic neuron and, as a result, increases the amount of these neurotransmitters in the extraneuronal spaces. Now Per Alm in his review (p.338) suggests two groups of stutterers, namely stimulant responsive and dopamine blocker responsive. So it appears that Alex may be in the latter group which Per Alm further characterizes as the stuttering/cluttering group. He also mentions that people in the cluttering group tend to have attention deficit disorders. So it appears that Alex may have too much dopamine in which case Adderall will increase his disfluency.
On the other hand, Strattera is also used to treat ADD, but it is not an amphetamine stimulant. Rather it acts only to block the reuptake of norepinephrine. The puzzle then is: Why does the action of Strattera improve Alex's fluency when there is no obvious connection (based on my present knowledge) of norepinephrine to dopamine?

Anonymous said...

OK it is backwards above...Alex had the opposite-- odd reaction to the ADD medicine--
Stratera (supposedly better for stuttering) made the stuttering MUCH worse.
Adderall slightly improved the already better fluency with Lexapro.
This is what is so hard to understand re: what is happening neurochemically.
Alex has ADD and significant stuttering, but no "neurological incident."
On the positive side, he doesn't have as much difficulty using the strategies or as significant a need to constantly monitor how he speaks.
Can the brain have too much dopamine(stuttering) and too little? (ADD)

JulieBD said...

I know this is a very old posting, but where/how can a person who stutters find testing to determine brain chemical levels?? Thanks

JulieBD said...

I know this is a very old posting but where/how can a person who stutters find testing to determine brain chemicals. We are assuming stuttering is caused by too much Dopamine but we are running into dead ends trying to find info.
Do we search for a Neuro Psychologist, Neurologist, etc??