An Overview of Aphasia in Multiple Sclerosis

Aphasia describes a partial or total loss of words, resulting in problems communicating with others. People with MS may experience aphasia if their condition affects the parts of the brain responsible for language. Aphasia in multiple sclerosis (MS) is rare.

This article discusses aphasia, what it is, and what it looks like. It also discusses how aphasia might affect people with multiple sclerosis.

What Is Aphasia?

Aphasia describes a loss of language and communication skills. People with aphasia may have difficulty with spoken or written words or may have trouble understanding what others are saying.

Types of Aphasia

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, but their language 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.

Causes of Aphasia

Aphasia is caused by some type of damage to the language areas of your brain, most often a stroke. 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.

Symptoms of Aphasia

People with aphasia 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 Multiple Sclerosis

Until recently, aphasia wasn’t thought to 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. When it does happen, it usually occurs with a variant of MS called tumefactive MS.

Tumefactive 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. This 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. Other symptoms may include:

• Seizures
• Impaired consciousness
• Motor impairment
• Visual field deficits

Few studies have been done on language impairments like aphasia that can occur in people with MS. However, in general, research suggests that these language impairments are often associated with general cognitive dysfunction that can occur in MS.

Treatment

Immunomodulating drugs like Rituxan (rituximab) or a stem cell transplant may be considered to treat a large MS relapse. Treatment with high-dose intravenous (IV) steroids may also be given for recovering acute neurologic deficits resulting from an MS relapse.

Speech and language therapy can help improve language skills in people with aphasia, though the outcome of therapy can’t be predicted for any one person, since aphasia affects people differently.

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 Friends and Loved Ones

• 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.
  

Summary

Aphasia describes the loss of language skills like speaking, writing, or understanding others. While it most commonly occurs as a result of a stroke or traumatic brain injury, it can rarely occur in MS as well.

Aphasia in MS happens when the condition affects the language centers of the brain. It may be treated with immunomodulating drugs like Rituxan, a stem cell transplant, and high-dose IV steroids. Speech and language therapy may also help.