Many people with multiple sclerosis (MS) experience speech problems as part of their MS symptoms. Speech disorders in MS occur as the result of brain lesions — the areas of damaged nerves and tissue brought on by MS. Lesions that develop in different parts of the brain and brain stem can cause a variety of changes to a person’s usual speech patterns.
These speech difficulties may come and go throughout the day, sometimes lasting for just a few minutes. They may also worsen when a person’s MS symptoms are relapsing (flaring up). Most people with MS experience only mild changes in their speech, although severe problems are possible. These changes may cause temporary or long-lasting difficulties.
There are ways to manage speech difficulties with MS. If you’re having problems speaking, get in touch with your neurologist. They may refer you to a speech and language therapist who can help you keep speaking and maintain clear communication.
Speech changes due to MS may cause a variety of disruptions to a person’s normal speech pattern.
Like other MS symptoms, MS speech problems can occur temporarily during a flare-up, or they can last longer. Some people find that their speech difficulties come and go in various situations or at different times of the day: “I have problems with speech at night when I’m really tired,” shared one member. “In the morning, my speech is back to normal.”
Another member wrote that they find speech more challenging when under pressure: “I speak much better when not answering questions, having to think, or being on the phone.”
Note that many people with speech difficulties also experience dysphagia (difficulty swallowing).
Some people may struggle to control the loudness of their voice, experiencing sporadic episodes of loud, rapid speech referred to as explosive speech.
Scanning speech is another speech pattern commonly associated with MS. Scanning speech occurs when the normal melody of a person’s speech pattern is disrupted, causing abnormally long pauses between syllables or words. This disruption in rhythm and intonation can result in speech that sounds robotic.
Some people with MS may slur their words, while others may speak nasally, as if they have a cold or a stuffy nose. Many MyMSTeam members have reported experiencing speech changes with their MS that make communicating difficult. As one member wrote, during a morning meeting, they were “stuttering, not talking clearly, [and] difficult to understand.”
There are several types of speech problems in MS, and dysarthria is the most common.
Dysarthria, the medical term for a motor speech disorder, affects about 40 percent of people with multiple sclerosis.
In people with MS, white blood cells — the body’s defenders — attack the central nervous system, which includes the brain and spinal cord. These attacks cause inflammation and strip the nerves of their myelin, which is the protective coating around nerves. This results in areas of nerve damage known as lesions or plaques. Dysarthria can occur when the damage affects parts of the brain and brain stem responsible for controlling speech.
Damage to different areas of the brain can result in different types of speech changes. Damage in one area may weaken the diaphragm (the muscle that plays a key role in breathing), reducing breath control and causing a person to speak more softly. Damage in other areas may affect the muscles in the lips and tongue, causing speech to become slurred, slower, or less precise.
Scanning speech and explosive speech are other forms of MS-related dysarthria. Both result from lesions in the cerebellum — the part of the brain responsible for motor skills, including muscle coordination. These two speech patterns feature a disruption in the coordination between the muscles responsible for articulation and exhalation, which are essential to volume control.
Although rare, dysphasia is another type of speech problem that can occur in people with MS. Unlike dysarthria, which occurs as the result of motor impairment, dysphasia is a language disorder. It results in a person having difficulty finding the right words to explain their thoughts (expressive dysphasia) or understanding what others are saying to them (receptive dysphasia).
One MyMSTeam member described their experience with dysphasia: “I stutter and can’t find my words a lot. I often find it hard to talk to people because I am afraid I’ll stutter or say something crazy.”
Multiple sclerosis can cause cognitive difficulties (sometimes called brain fog), which can affect the way a person speaks in some cases. Cognitive difficulties usually result in only mild speech problems related to memory and word-finding.
Some medications used to treat MS symptoms like bladder problems can lead to dry mouth as a side effect, which may make speech more difficult. Talk to your doctor if you experience this side effect. They may be able to change your medication or adjust your dosage.
Communication plays a huge role in our day-to-day lives. Experiencing problems with the way you communicate can be upsetting. As one member wrote, “I get so sick of people saying they can’t hear me.” Another shared, “I will be talking and just searching for that word that I’m trying to say to explain what I’m trying to say — if that even makes sense … It stops me midsentence as I go searching, and everyone is looking at me, and I feel so foolish, which makes me not want to talk.”
There are several ways that you and your health care team can work together to help improve and manage MS-related speech problems, generally through speech and language therapy.
Breathing exercises often involve practicing breathing in and out in a controlled way, ultimately allowing you to form longer sentences with one breath. A speech therapist may also direct you through exercises to take pauses between phrases, emphasize certain words in a sentence, and monitor your breathing while speaking.
Some speech difficulties can affect voice volume and pitch or cause breathiness or hoarseness while speaking. A speech therapist can recommend exercises to relax or strengthen the muscles that control the vocal cords. Other exercises can help improve articulation and pronunciation by altering the movement of the jaw, tongue, and lips.
As one MyMSTeam member shared, “The things that I have to remember are to slow down my rate of speech, increase my pitch, and exaggerate my words.”
Assistive devices known as communication aids can help people with significant speech problems communicate by translating written words into speech, for example. Other MS symptoms, such as tremors or vision problems, may make using certain aids unusable. A speech and language therapist can help recommend the appropriate device.
Posture may also affect your speech. A physiotherapist can help you improve your posture in a way that works with your physical abilities. Using a pillow or foam supports while seated or lying down may also help maintain good posture and promote clearer speech.
Making certain adjustments to your environment and way of communicating may help make spoken conversations easier. Be sure to have someone’s full attention before speaking to them, and don’t try to compete with other noise, such as a TV.
Communicating face to face also provides important nonverbal cues — like body language and facial expressions — that may make it easier to get your ideas across. If you have trouble with finding the right word or remembering what you are trying to communicate, it may be helpful to use notes or remind yourself to slow down while speaking.
Speech problems are just one of the symptoms of MS that can be challenging in day-to-day life. It may help to know you’re not alone. MyMSTeam is the social network designed for people with multiple sclerosis and their loved ones. Here, more than 192,000 members who understand life with MS gather to ask questions, give advice, and share support.
Have you experienced speech problems with MS? If so, how have you managed them? Share your tips in the comments below or by posting on MyMSTeam.