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Klinische Neurophysiologie 2015; 46(03): 136-140
DOI: 10.1055/s-0035-1559701
Originalia
© Georg Thieme Verlag KG Stuttgart · New York

Stottern: Klassisches Problem gestörter Bindung zwischen kortikalen Sprach- und Sprechzentren

Stuttering: Classical Problem of Disturbed Link between Cortical Speech and Language Centers
M. Sommer
1   Klinik für Klinische Neurophysiologie, Universitätsmedizin Göttingen
,
W. Paulus
1   Klinik für Klinische Neurophysiologie, Universitätsmedizin Göttingen
› Author Affiliations
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Publication History

Publication Date:
25 September 2015 (online)

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Zusammenfassung

Ziel der Studie: Stottern ist eine häufige Redeflussstörung, die als Kontrollverlust der Sprechmuskulatur erlebt wird. Studien jüngerer Zeit vertiefen unser Wissen über die neurophysiologischen Grundlagen dieses Kontrollverlustes.

Methodik: Nach einer Übersicht zu Phänomenologie, Epidemiologie und strukturell sowie funktionell bildgebenden Daten führen wir 2 kürzlich erschienene Studien zur Erregbarkeit der primär motorischen Repräsentation der Zunge aus. Diese untersuchen unter Verwendung transkranieller Magnetstimulation hemmende und bahnende Regelkreise sowie die sprechvorbereitende Modulation der motorkortikalen Erregbarkeit.

Ergebnisse: Die intrakortikale Fazilitation des primären Zungenmotorkortex ist bei stotternden Erwachsenen im Vergleich zu Kontrollpersonen vermindert. Dies unterscheidet Stottern von anderen Bewegungsstörungen, bei denen die intrakortikale Fazilitation intakt ist. Die sprechvorbereitende Steigerung der Erregbarkeit des primären Motorkortex fehlt bei stotternden Erwachsenen in einem mit der Stotterschwere korrelierenden Ausmaß.

Schlussfolgerung: Der Befund einer gestörten Erregbarkeitsmodulation des Motorkortex ermöglicht ein besseres Verständnis der beteiligten Regelkreise der Bewegungsinitiierung und erlaubt Analogien zu Initiierungsstörungen wie dem freezing of gait bei Parkinson-Syndromen.

Abstract

Aim: Stuttering is a common speech fluency disorder characterized by breakdowns in speech motor control. Recent studies deepen our knowledge of the neurophysiological basis of this loss of motor control.

Methods: After an overview of phenomenology, epidemiology and structural and functional imaging data, we describe in detail 2 recent studies on the excitability of the tongue primary motor representation. Using transcranial magnetic stimulation, these studies investigate the balance between inhibiting and facilitating intracortical interneurons, and the speech-dependent modulation of motor cortical excitability.

Results: The intracortical facilitation of primary tongue motor cortex is reduced in adults who stutter compared to control subjects. This differentiates stuttering from other movement disorders in which intracortical facilitation is intact. A speech preparation-dependent increase in the excitability of the primary motor cortex is absent in adults who stutter to an extent correlating with stuttering severity.

Conclusion: The impaired modulation of motor cortex excitability links stuttering to areas of sequential movement initiation and allows drawing an analogy to impaired movement initiation of freezing of gait in Parkinson’ disease.

Schlüsselwörter

Stottern - Motorkortex - transkranielle Magnetstimulation - Bewegungsinitiierung

Key words

stuttering - motor cortex - transcranial magnetic stimulation - movement initiation
 

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