Overview of Aphasia in Multiple Sclerosis

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Aphasia in MS. Huntstock / Getty Images

Generally speaking, aphasia is a partial or total loss of words, resulting in problems communicating with others. People with aphasia may have an:

  • Inability to speak clearly and/or to understand what other people say
  • Inability to write clearly and/or understand written words

If that sounds to you like a really distressing condition, you’re right. Imagine the emotional pain of not being able to fully connect with family members, friends, and others in conversation or in writing. In fact, in a study asking almost 70,000 patients with 60 diseases about how greatly 15 health-related factors affected their quality of life, aphasia was found to have the greatest impact of all. That included having a greater negative impact on quality of life than either cancer or Alzheimer’s disease

Types of Aphasia

Doctors classify aphasia into three types:

  • Expressive Aphasia: Problems using words and sentences
  • Receptive Aphasia: Problems understanding others
  • Global Aphasia: Problems with both using words and understanding others

Keep in mind that aphasia should be distinguished from problems affecting the voice (ability to produce speech) in people with MS, such as dysarthria or dysphonia. These speech disorders in MS may lead to specific patterns of speech like scanning speech, nasal speech, or slurring words. In addition, people with dysarthria (problems speaking) from MS often have difficulties swallowing (called dysphagia).

Aphasia is Rare in MS

Until recently, aphasia wasn’t thought to ever be a symptom of multiple sclerosis (MS). That was because MS mainly involves the white matter of the brain and spinal cord. In contrast, aphasia occurs most often in people with diseases involving the gray matter that damage the cerebral cortex, the part of the brain responsible for language.

However, now we know that aphasia may occur in MS, although it's rare, and usually occurs with a variant of MS called tumefactive MS. This type of MS resembles a brain tumor and is characterized by one or more large demyelinating lesions, seen on an MRI, along with swelling and something called mass effect (meaning the lesions are so big, they are are pushing on surrounding brain tissue).

A person with tumefactive MS may have a variety of symptoms depending on the size and location of the lesion(s), but sudden aphasia is a possible symptom, along with seizures, impaired consciousness, and visual field deficits.

Treatment of Aphasia

There’s no cure for aphasia, but marked improvement may be seen when acute aphasia results from a large MS relapse (usually related to tumefactive MS). Treatment with high-dose intravenous (through the vein) steroids is important for optimizing language restoration. Immunomodulating drugs like Rituxan (rituximab) or stem cell transplant may also be considered to treat such a large MS relapse.

Speech and language therapy can also help improve language skills. In the end, aphasia affects people differently, so the outcome of therapy can’t be predicted for any one person.

That said, there are some things you, as a loved one, partner, or friends, can do to help a person with aphasia feel more comfortable and at ease speaking:

  • Keep your sentences simple and short.
  • Don’t ask questions that call for complicated answers.
  • Don’t “change the subject” abruptly.
  • Keep background noise to a minimum.
  • Be patient: Give the person plenty of time to respond to what you’ve said.
  • Don’t correct the person’s grammar or usage.
  • Keep in mind that difficulty speaking can affect the tone of voice as well as word selection. The person’s tone may not always reflect his or her mood.
  • Have some paper and a pen or pencil handy.

Another way you can help is to suggest tips for helping to keep words in memory so the person can “find” them more easily. For example, help him or her focus on:

  • The first letters of important words
  • “Cues” to remembering words, such as the categories of things that include them – for example, connecting the word “cooking” with “kitchen things”

A Word From Verywell

While aphasia most commonly occurs as a result of a stroke or traumatic brain injury, it may rarely occur in multiple sclerosis, typically with an uncommon variant of MS called tumefactive MS.

With that, if you develop sudden difficulty speaking, finding words, or understanding language, be sure to seek medical attention right away. Emergency room doctors will want to rule out stroke, which requires immediate treatment.

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