Dysfluency pearls: Stuttering, cluttering & palilalia

1. Developmental stuttering usually is made better by singing, repetitive reading of same passage (adaptation) and playing white noice in patient's own ear to prevent him from hearing his own speech . There is no neurologic lesion or evaluatin required.

2. Acquired stuttering can occur with multiple location small brain lesions and does require MRI. Unlike developmental stutterers, acquired stutterers are dysfluent throughout a sentence, not just at the beginning, and are generally not bothered or embarassed by the deficiency.

3. Cluttering is characterized by rapid speech, repetitions, omissions, interjections and disturbed prosody. Sounds and syllables may be inverted or omitted. Clutterers may repeat initia sounds and prolong sounds within the word. Clutterers are not concerned about the problem and usually do not need neurologic evaluation.

4. Palilalia is characterized by compulsive repetition of words and phrases at increasing speed and with a decrescendo phonatory volume, and occurs in Parkinson's disease and pseudobulbar palsy. It improves considerably when the patient speaks with a metronome.