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( Personally , he prefers the last because it doesn ’ t cause as much weight gain as the others .) The result : “ Your stuttering won ’ t completely go away , but we can treat it ,” he says .
None of those medications are approved for stuttering by the US Food and Drug Administration , and they can cause unpleasant side effects , not just weight gain but also muscle stiffness and impaired movement . In part , that ’ s because they act on the D2 version of the dopamine receptor . Maguire ’ s new medication , ecopipam , works on the D1 version , which he expects will diminish some side effects — though he ’ ll have to watch for others , such as weight loss and depression .
In a small study of 10 volunteers , Maguire , Yaruss and colleagues found that people who took ecopipam stuttered less than they did pre-treatment . Quality-of-life scores , related to feelings such as helplessness or acceptance of their stutter , also improved for some participants . Ecopipam isn ’ t the only treatment under consideration . Back in Michigan , Chang hopes that stimulation of specific parts of the brain during speech could improve fluency . The team uses electrodes on the scalp to gently stimulate a segment of the hearing area , aiming to strengthen connections between that spot and the one that manages speech movements . ( This causes a brief tickle sensation before fading , Chang says .) The researchers stimulate the brain while the person undergoes traditional speech therapy , hoping to enhance the therapy ’ s effects . Because of the Covid-19 pandemic , the team had to stop the study with 24 subjects out of a planned 50 . They ’ re analyzing the data now .
Connecting the dots Dopamine , cellular waste disposal , neural connectivity — how do they fit together ? Chang notes that one of the brain ’ s circuits involved in stuttering includes two areas that make and use dopamine , which might help explain why dopamine is important in the disorder .
She hopes that neuroimaging can unite the different ideas . As a first stab , she and collaborators compared the problem areas identified by her brain scans to maps of where various genes are active in the brain . Two of Drayna ’ s genes , GNPTG and NAGPA , were active at high levels in the speech and hearing network in the brains of nonstutterers , she saw . That suggests those genes are really needed in those areas , bolstering Drayna ’ s hypothesis that defects in the genes would interfere with speech .
The team also observed something novel : Genes involved in energy processing were active in the speech and hearing areas . There ’ s a big rise in brain activity during the preschool years , when stuttering tends to start , Chang says . Perhaps , she theorizes , those speech-processing regions don ’ t get all the energy they need at a time when they really need to be cranking at maximum power . With that in mind , she plans to look for mutations in those energy-control genes in children who stutter . “ There are obviously a lot of dots that need to be connected ,” she says .
Maguire is also connecting dots : He says he ’ s working on a theory to unite his work with Drayna ’ s genetic findings . Meanwhile , after struggling through med school interviews and choosing a career in talk therapy despite his difficulties with speech , he ’ s hopeful about ecopipam : With colleagues , he ’ s starting a new study that will compare 34 people on ecopipam with 34 on placebo . If that treatment ever becomes part of the standard stuttering tool kit , he will have realized a lifelong dream .