Multiple sclerosis (MS) is the commonest disease of the central nervous system (CNS) among young adults. It affects more than one million people world-wide and about 85,000 in the UK. About twice as many women as men are diagnosed with MS.
The CNS comprises the brain and spinal cord, which, with the nerves connecting to the rest of the body, form the body’s communication network. Nerves are protected by a covering called the Myelin sheath. This is often likened to insulation materials around an electric wire. In MS, the myelin sheath is damaged. This damage alters the way messages (nerve impulses) are conducted to and from the brain, which will disrupt normal functioning of the body.
MS can affect any part of the body. The most common symptoms are: double or blurred vision; loss of sight in one eye; spasticity or tremors; bladder and bowel problems; poor co-ordination; weakness and fatigue; tingling, pins and needles, numbness and itching. People with MS could also experience difficulties with their speech and swallowing (see ‘Multiple Sclerosis and swallowing difficulties’ sheet).
Speech difficulties affect between 40 and 50 per cent of people with MS. These difficulties can come and go throughout the day; perhaps lasting only a few minutes at a time, and may be a symptom that appears during a relapse. A speech and language therapist can help you find practical ways to manage these changes.
There are different types of speech difficulties, which may be caused by MS. This is because different parts of the brain can be affected. The most common form is when muscles of the tongue and lips become weak and do not move as precisley or as quickly as they used to. Therefore speech can sound slurred. This is known as dysarthria.
MS can affect the diaphragm, which controls breathing and volume of speech. Therefore speech can be very quiet or you may run out of air when you are talking. This is known as dysphonia.
MS can affect the way speech movements are coordinated therefore speech can sound halting, monotone and uncontrolled. This is known as ataxic speech.
Managing speech difficulties may be more effective if the problem is picked up early, even if changes are small. Some of the signs will be obvious, others may be more subtle. Sometimes, changes in speech are so small that you may not notice them yourself. It could be friends and family who are first aware of a change.
A speech and language therapist can help diagnose your speech problem and work with you to find ways to manage it that suit you best – tailored to your own needs and situation. MS is an unpredictable condition, so a speech and language therapist may assess your needs regularly, to see if your situation has changed, and if treatments are still effective. The first step in managing speech difficulties is to identify the specific problem, or problems, you are having. A speech and language therapist will carry out different tests with you to see exactly which parts of the speech process are affected.
For many people, overcoming changes in speech involves learning how to compensate for problems, and finding ways to make communication as easy as possible. Speaking is the main way we communicate, so if it becomes difficult to talk, this can be distressing, frustrating and tiring. It is important that the emotional side of speech difficulties is not ignored because stress and anxiety, for example, may make difficulties worse.