Speech Problems in Multiple Sclerosis

Among the most frustrating complications of multiple sclerosis (MS) are disorders that interfere with the ability to speak clearly. One of these is dysarthria, a motor disorder that makes it hard to control the muscles used for speaking, including (or those involving) the lips, tongue, jaw, soft palate, vocal cords, and diaphragm.

According to the National Multiple Sclerosis Society (NMSS), between 41 percent and 51 percent of those living with MS are affected by dysarthria. It’s usually mild; however, symptom severity reflects the extent of nerve damage, as well as the type of disease course. 

The Three Types of Dysarthria in MS

There are three different types of dysarthria in people with MS.

Spastic dysarthria mainly featuring muscle stiffness or tightness. It is characterized by voice features like:

• A harsh, strained voice quality
• A slow rate of speech
• Reduced loudness or monotone speech

Ataxic dysarthria mainly featuring loss of muscle movement control. It is characterized by the following voice features:

• A vocal tremor
• Dysrhythmic, rapid, and alternating movements of the tongue, lips, and jaw
• Scanning speech, in which words come out very slowly or in strange rhythms with the syllables between them separated by long pauses, slurred speech, mumbling, or very slow speech
• Excess and variable loudness

Mixed dysarthria combines features of both the spastic and ataxic types, and is most common in people with MS because of the disease's effect multiple areas of the nervous system. In mixed dysarthria, nerve damage may involve your brain’s white matter and/or cerebellum, your brainstem, and/or your spinal cord.

Treating Speech Problems

Fortunately, speech problems in MS can be managed in several ways.

Speech Therapy

Getting help from a speech-language pathologist (SLP) can be an effective way to deal with communication problems caused by MS.

An SLP will first evaluate your speech to figure out exactly what to focus on in your treatment. He or she will then meet with you one-on-one in therapy sessions and give you exercises to do on your own.

Your SLP may help you work on strengthening your speech muscles and increasing your tongue and lip movements, learn to speak more slowly, and teach you to use your breath more effectively when you talk.

Different technologies are available for self-monitoring, including recording devices and computer speech-analysis software. This may be an especially important step to take if you're worried your speech problem is impacting your work or social life. Ask your speech pathologist more about these if you think they may be useful to you.

Medication

Unfortunately, no medications are available that directly help improve MS-related speech problems. However, medications that relieve symptoms such as muscle stiffness or tightness (spasticity) may provide some speech improvement.

Medications used to treat spasticity, including Ozobax and Fleqsuvy (baclofen) and Zanaflex (tizanidine), may be useful in cases where spasticity is affecting muscle tone in the vocal cords, tongue, lips, soft palate, or the diaphragm.

Tremors can also affect voice quality and vocal muscles directly or indirectly. Medications to treat tremor include Klonopin (clonazepam), Inderal (propranolol), Mysoline (primidone), and Doriden (glutethimide).

Fatigue can affect the muscular coordination and strength necessary for vocal production. Medications that can be helpful in this regard include Symmetrel (amantadine), Provigil (modafinil), and Nuvigil (armodafinil).

Getting enough sleep when you have MS is also critical in general and may also help to reduce speech-related symptoms.

Tips for Coping

It can be very frustrating to want to communicate, but not be understood. If your speech has been affected by MS, these strategies can help your interactions with others.

Inform Others of Your Challenges

If you've ever heard a recording of yourself speaking, you know how different your voice can sound on tape from what you hear in your head. It's the same thing when you talk to other people—they may find your speech to be much clearer than you think it is.

If you are concerned about how you sound, don't hesitate to give your listener a heads-up and tell them you sometimes struggle to express yourself clearly.

Take a Break

In the heat of a moment of frustration, communicating clearly can be difficult for anyone. You may find it particularly challenging.

Take a few minutes to regroup. Breathe in deeply until you feel ready to go back to your conversation. When you do, keep your sentences short and speak slowly.

Communicate in a New Way

Very rarely, dysarthria caused by MS can leave a person unable to be understood—or even speak—at all. In that case, there are various workarounds to try, including alphabet boards, note pads, hand gestures, sign language, and electronic or computer-based aids.

A Word From Verywell

Scanning speech and other symptoms of dysarthria don't create physical pain, but they can lead to anxiety, frustration, and a lack of self-confidence. Don't hesitate to seek help.