Objective: To review and present a common abnormality — attention to action— underlying Parkinsonian and conversion speech disorders.

Background: Conversion speech disorders are characterized by sudden, marked, and persistent deterioration in voice (aphonia, dysphonia, dysprosodia), articulation (distorted vowels and or consonants) and speech fluency (stuttering). These speech abnormalities are incongruous with any medical findings. Importantly, these speech abnormalities typically respond well to behavioral speech therapy, within a single treatment session, and without regression (Sapir, S. (1995). Journal of Voice, 9, 270-81). Parkinsonian speech disorders are characterized by hypophonia (weak, hoarse, whisper voice), hypoprosodia (reduced prosodic intonation), and hypokinetic speech articulation. Importantly, when a patient with Parkinson’s disease is asked to speak with a loud and clear voice, the voice becomes much louder, clearer, and with improvement in speech articulation and prosody. Importantly, this dramatic improvement lasts only a few seconds or minutes, and the patient regresses to poor speech. The speech abnormalities are likely related to a deficit in attention to action (Sapir, S. (2014). Journal of Speech, Language, and Hearing Research, 57, 1330-1343.).

Methods: Videotapes of three young healthy women with conversion voice disorders, and two older men with Parkinson dysarthria (mainly voice disorders), will illustrate the two phenomena (conversion and Parkinsonian motor speech disorders). Brief review of brain imaging studies regarding conversion disorders will also be discussed.

Results: All five patients show severe speech (mainly voice) disorders, with dramatic improvement in a single session, with the improvement maintained throughout the session and for many months or years at follow up for the conversion disorder, while showing regression in the Parkinsonian speech.

Conclusions: These findings suggest a common mechanism underling the conversion and Parkinsonian speech disorders, most likely associated with the basal ganglia and their links with the cortex and subcortical network. These findings are of theoretical and clinical importance. Much more research is needed to understand these phenomena.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/attention-to-action-common-to-both-conversion-psychogenic-and-parkinsonian-neurogenic-motor-speech-disorders/