An Overview of Aphasia in Multiple Sclerosis

This language impairment is rare in MS, but possible

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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. If this sounds like a distressing condition, you’re right. In fact, in a study asking almost 70,000 long-term care residents with 60 diseases about how greatly 15 health-related factors affected their quality of life, aphasia was found to have the greatest negative impact, even more than either cancer or Alzheimer’s disease. Fortunately, while possible, aphasia in multiple sclerosis (MS) is rare.

Types

There are many types of aphasia and which type a person has depends on which part of the brain is damaged. Some of the most common ones include:

  • Expressive aphasia: Also known as Broca's aphasia or non-fluent aphasia, this type involves difficulty speaking or writing, though the person understands most speech.
  • Fluent aphasia: More commonly called Wernicke's aphasia, this type affects the ability to understand what others are saying. People with fluent aphasia are able to speak themselves, but it may not make sense or be unintelligible.
  • Global aphasia: This type involves an inability both to speak and to understand others, whether it's through spoken or written words.
  • Anomic aphasia: In this type of aphasia, people have difficulty remembering the names of certain objects, though they may be able to speak and use verbs appropriately.
  • Alexia: People with alexia are unable to recognize written words and may have difficulty understanding spoken words as well.

Keep in mind that aphasia should be distinguished from motor disorders affecting the ability to produce speech in people with MS, such as dysarthria or dysphonia. These disorders may lead to specific patterns of speech like scanning speech, nasal speech, or slurring words, which is distinctly different than what happens in aphasia.

Causes and Symptoms

Aphasia is caused by some type of damage to the language areas of your brain, most often a stroke. But it can occur as the result of other causes of brain damage as well, like a traumatic head injury, brain infection, a brain tumor, or progressive neurological disorders like Alzheimer's disease. Rarely, it can be caused by demyelinating lesions due to MS.

As you can see from the different types of aphasia, people with it may have one or more symptoms that cause difficulty or an inability to do the following:

  • Speak or speak clearly
  • Understand what other people say
  • Write clearly
  • Understand written words
  • Speak or understand both spoken and written words
  • Remember the names of specific objects

Aphasia in MS

Until recently, aphasia wasn’t thought to ever be a symptom of multiple sclerosis at all. This 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 scientists know that aphasia may occur in MS, although it's rare, and that it 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 that are seen on a magnetic resonance imaging (MRI) scan, along with swelling and something called mass effect, which means the lesions are so big that they push 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, motor impairment, and visual field deficits.

Few studies have been done on language impairments like aphasia that can occur in people with MS, so there isn't much information to go on. However, in general, research suggests that these language impairments are often associated with general cognitive dysfunction that can occur in MS.

Treatment

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 (IV) steroids is important for optimizing language restoration. Immunomodulating drugs like Rituxan (rituximab) or a stem cell transplant may also be considered to treat such a large MS relapse.

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

Coping

If you are the one with this condition, your ability to cope with it may be greatly helped by those around you doing what they can to help you feel more comfortable and at ease speaking.

Tips for loved ones and friends:

  • 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 so the person can write down words if they simply can't get them across.

A Word From Verywell

While aphasia most commonly occurs as a result of a stroke or traumatic brain injury, it can rarely occur in MS too. 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 a stroke, which requires immediate treatment.

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