Patrick Thornton is a 40-year-old teacher from Huston, Texas. He started feeling sick back in August 2020 and the same month he tested positive for COVID 19. By the end of September, he was on his road to recovery. He no longer had a temperature, headache, shortness of breath, cough, or congestion. His sense of taste and smell was back. These were obviously good news.
He also had a sore throat which was gradually improving and by mid-September, he had his voice back! So imagine his surprise when his mom’s call woke him up on September 25 from a nap and he found himself struggling to get the words out. He knew right then “some of the words didn’t feel right in” his mouth.
In his own words, “that was terrifying”. As a teacher, he relies on the clarity of his voice to communicate with his students. But on that fateful day, the Daily Mail reported, he woke up with a stutter that still persists.
By November, Thornton was still fighting the post-COVID19 fatigue. He had occasional chest pain and dizziness. However, his stutter had also become worse.
COVID 19 and Stuttering: Is There Really a Link?
Studies show that Thornton’s isn’t an isolated case. A recent report published in The Lancet Psychiatry states that out of the 123 patients with complete clinical history, 21 patients showed signs of mental health problems. Six patients show dementia-like (neuro-cognitive) symptoms.
Stuttering is a speech disfluency disorder. Recent research shows that people who stutter since childhood have anomalous brain structures. Stuttering has its roots in genetics and the difference in brain structure sometimes contributes to functional changes. For example, brain imaging studies also show that people who stutter have deviant sound processing and production processes.
Can Adults Develop Stuttering Out-of-the-Blue?
Rarely, a small fraction of the adult population develop stuttering in their adulthood. They typically have no history of stuttering in their family. Adult stuttering is not as common. There can be multiple reasons an otherwise fluent adult develops stuttering all of a sudden in adulthood.
Neurogenic stuttering is the result of nerve damage or altered nerve functions. It can happen due to injuries or hemorrhaging in the brain. In rare cases, people who recover from encephalitis, brain stroke, brain tumor, or cancer can also show signs of speech disfluency.
Neurodegenerative diseases and some autoimmune diseases may also trigger disfluent speech in adults. They may talk in a fragmented, staggered, or halting fashion which sounds just like developmental stuttering.
Sometimes, severe concussions have resulted in stuttering that speech-language pathologists (SLPs) have categorized as neurogenic.
According to experts, psychogenic stuttering can result from deep-seated emotional trauma from childhood or even adolescence.
Severe psychological trauma including sudden loss, witnessing violence, or becoming a victim of violence or abuse can precipitate stuttering in some individuals who have no previous history of stuttering.
It is drug-induced stuttering. Some people show adverse reactions to clozapine, risperidone, and buproprion. They begin stuttering either when they start taking the drug(s) or when they increase the dosage.
Pharmacogenic stuttering is typically reversible. The patient can talk to the doctor and stop the medication or alter the dosage.
What is The Nature of Stuttering Caused by COVID 19?
The nature of stuttering that many adults are reportedly experiencing after recovery from COVID 19 may be neurogenic in nature. Although extreme conditions of stress, anxiety, and fear can trigger stuttering, it is not observed in fluent adults who have not tested positive for COVID 19.
Adults already struggling with stuttering have witnessed their blocks and repetitions become worse due to isolation, anxiety, and fear. However, the type of stuttering noticed in patients who have recovered or are recovering from COVID 19 has its roots in the nervous system.
The drugs involved in the treatment of SARS CoV2 infection do not have a history of inducing stuttering. Therefore, it is possible to rule out pharmacological causes in the sudden onset of stuttering in recovering individuals.
On the other hand, autopsies on severe COVID 19 patients indicate the presence of the whole virus and, sometimes, the viral particles in the brain. Studies have shown the presence of viral particles in and near the trigeminal nerves of deceased COVID19 patients.
There is strong evidence that the S1 protein from SARS CoV2 virus can readily cross the blood-brain barrier. Mouse model studies conducted by Rhea et al in 2020 show that intranasally introduced radiolabelled S1 protein from the COVID 19 virus can cross the blood-brain barrier almost instantly.
Tender and genetic makeup of the mice apparently do not affect the capability of the S1 protein to cross the blood-brain barrier.
What may be Causing Stuttering in COVID 19 Patients?
Over the past six months, evidence concerning the long-term effects of COVID 19 has been pouring in. These are individuals who have recovered from the disease, tested negative, but still suffer from the aftermath. The Daily Mail reports that studies involving 153 patients in the UK show that more than one-third suffer from brain fog, psychosis (without any history), dementia-like memory problems, speech problems, and brain swelling.
Soo-Eun Chang, a leading neuroscientist at the University of Michigan, says, “Anxiety and stress don’t cause stutter, but they can exacerbate it”.
Thornton’s doctors insist that once his stress subsides, his stutter, too, will subside. In the meantime, he says it has only become worse. Amanda Wood, from Indianapolis developed a stutter during her recovery period from the novel Coronavirus infection.
One of the leading theories is that the COVID 19 virus mounts a strong immune response that produces bulks of cytokines. These cytokines can also cross the blood-brain barrier and are capable of attacking even healthy tissues. It is similar to an autoimmune disease, which can lead to an immune-mediated attack on nerves and parts of the brain.
So, even in milder cases, where the COVID 19 virus or the protein particles don’t make it to the brain, there is a good chance that cytokines (autoantibodies) can sneak in and wreak havoc on the brain functions of an individual.
Is There a Cure For Stuttering Caused by COVID 19 infection?
Currently, there isn’t enough research on the autoimmune response caused by the COVID 19 infection or the effects of the viral infection on the human brain. However, it is clear that undoing the damage caused by the infection will take time, research, and a lot of patience.
Can COVID 19 cause stuttering? Yes! Along with a plethora of other psychological and physiological issues.
Can stuttering caused by the novel Coronavirus be cured? Guess, we will have to wait for people like Mr. Thornton to recover to find our ray of hope.
Till then all we can do is stay home, wash and sanitize our hands, wear a mask, and maintain social distance.