Speech Dysfunctions In Multiple Sclerosis

Few attempts have been made to use degree and type of Multiple Sclerosis (MS) Dysarthria in Neurological Evaluation.

In the present study, 77 individuals drawn from an MS population were examined both by a Speech Pathologist and a Neurologist, and data from three sources of information were subsequently combined:

1. A clinical Dysarthria test procedure
2. A Perceptual analysis of Speech characteristics in Continuous Speech
3. Neurological Deficit Scoring.

The speech of 15 age- and gender-matched healthy control subjects was also investigated. It was concluded that:

1. The prevalence of mild to severe Dysarthria in this cohort was 51% and occurred in all components of Speech production: Respiration, Phonation, Prosody, Articulation and Nasality.

2. The clinical Dysarthria test was sensitive in detecting SubClinical Speech Signs. The prevalence of Pathologic Speech signs found on the basis of the test was found to be 62%. The prevalence of Dysarthria based on the Neurological Evaluation alone was 20%.

3. The Dysarthria of MS was a predominantly mixed Dysarthria, with both Ataxic and Spastic Speech signs frequently present in the Speech of a given individual.

4. Furthermore, when a predominant type of Dysarthria existed, it was not generally associated with a characteristic profile of Neurological Deficits.

Rather, severity of Speech Deviation was positively correlated to overall severity of Neurological involvement, type of disease course, and number of years in progression.

Copyright 2000 S. Karger AG, Basel

Introduction
The Paroxystic clinical features of Multiple Sclerosis (MS) include Trigeminal Neuralgia, Itch, Transient Diplopia, Lhermitte's Sign, Akinesia, Dystonia, Uhthoff's Phenomenon and others which are very characteristic, such as Paroxystic Ataxia and Dysarthria.

Clinical Case
We present the case of a 30 year old man who consulted for multiple episodes lasting only a few seconds, of complete inability to Speak. This symptom recurred several times a day and in many different situations.

It was often triggered off by external stimuli such as having to speak in front of several people. The disorder disappeared without treatment seven days after onset.

Magnetic Resonance using fast Spin Echo image sequences showed multiple HyperIntense lesions in MidRight Cerebellar Peduncle, Right Pons, Left Temporal Lobe, White Substance of both Internal Capsules, PeriVentricular and Semioval Centres.

Biochemical study of the CerebroSpinal Fluid showed that there were 9 Cells/Microliter (mainly Lymphocytes), proteins 45 mg/dl and a normal Glucose level.

The Tibling-Link level was 0.73. Cortical Somestesic Evoked Potentials showed slowed conduction after stimulation of the right Median Nerve and both Peroneal Nerves.

Acoustic Evoked Potentials of the BrainStem were conducted more slowly by the Right Acoustic Pathway at intraxial level. The patient was diagnosed as having clinically defined MS.

Conclusions
We consider that our patient's symptom was a kind of Paroxystic Dysarthria which we call Paroxystic Anarthria.

Differential diagnosis of this symptom should be basically with Phonatory or Dysphasic simple Partial Seizures.

Dysarthria occurs in approximately 40% of all patients with MS, when Speech and Voice Disturbances do occur, they usually present as a Spastic-Ataxic Dysarthria with Disorders of Voice Intensity, Voice Quality, Articulation, and Intonation.

While language disturbances such as Aphasia, Auditory Agnosia, Anomia, Dysgraphia, and Dyslexia are very rare in MS, Cognitive Deficits and Swallowing Disorders are common.

Treating Dysarthria, Dysphagia, and Cognitive Deficits in MS patients is effective for reestablishing functional daily activities.

The types, severity, and rates of deterioration in MS are highly variable; complete restoration to normal functioning is therefore not always expected.

For these reasons, careful documentation of clinical-treatment outcomes and the factors influencing these outcomes should be regularly collected and reported.

A physiological analysis of the articulatory function of 16 adults with Multiple Sclerosis (MS) was performed using lip and tongue transduction systems.

Sixteen NonNeurologically impaired adults, matched for age, gender, and education, served as controls.

The MS speakers demonstrated patterns of tongue function that were significantly different from those of the control speakers. Specifically, the MS speakers were found to have significantly reduced tongue strength, endurance, and rate of repetitive movements.

In addition, preclinical signs of Lingual Dysfunction were evident in NonDysarthric MS speakers on endurance and rate tasks when compared to control subjects.

These physiological findings could account for the perceptual findings of impaired articulation and reduced intelligibility. No lip dysfunction was found on either the physiological or perceptual assessments.

We report a 30-year-old man with adult type AdrenoLeukoDystrophy (ALD) who manifested an acute onset and repeated episodes of Ataxic Dysarthria.

He noticed a moderate Dysarthria after a high grade fever in February of 1995; however, two weeks later his symptom disappeared completely. Three months later, he noticed the Dysarthria again and he was referred to our hospital for further examination.

General physical findings on admission revealed a dark skin color, pigmentation of Gingivae and reduced body hair. Neurologically he was normal except for a moderate Ataxic Dysarthria.

Cranial T₂-weighted MRI showed multiple high intensity lesions in the SubCortical White Matter of Frontal Lobe, bilateral PeriTrigonal White Matter, Splenium of the Corpus Callosum and bilateral Cerebellar White Matter.

Only Cerebellar lesions responsible for his symptom were enhanced on MRI after Gadolinium administration.

Initially we diagnosed him with Multiple Sclerosis (MS) based upon the clinical course and MRI findings, and then started CorticoSteroid treatment.

His Dysarthria was slightly improved after the treatment and bilateral Gadolinium-enhanced lesions of Cerebellar White Matter on MRI disappeared.

Multimodality Evoked Potentials such as short latency SomatoSensory Evoked Potentials, BrainStem Auditory Evoked Potentials and pattern-reversal Visual Evoked Potentials, disclosed a Prolonged Central Conduction Time associated with bilaterally symmetric individual interpeak latencies.

These findings, which supported diffuse and bilateral subclinical DeMyelinating Lesions in the Central Nervous System, were unusual for MS; therefore his Plasma Very-Long-Chain Fatty Acids (VLCFA) were assayed for ALD.

Finally, he was diagnosed with adult type ALD because of the high ratio of C26: 0/C22: 0 (0.075; normal 0.033). It is very difficult to clinically distinguish the early stage of adult type ALD especially in patients like this from MS.

Therefore it is useful and important to evaluate not only the level of Plasma VLCFA, but also to evaluate multimodality Evoked Potentials.

Traditionally, Prosodic difficulties in Dysarthria have been described in Phonetic terms with little attention being paid to the Phonological implications of these impairments. This cast study attempts to illustrate the need for a Phonological level of analysis.

The Speech of a 30-year-old Ataxic Dysarthric is analyzed using Crystal's framework and the patterns are discussed, in terms of the effect of the Phonetic difficulties, on the speaker's ability to use his intonation system to mark meaning contrasts.

The analysis reveals that this speaker has developed a personal subsystem, where he retains some of the features of 'normal' Speech and systematically exploits variables still under his control, to compensate for other deficits.

This study highlights both the value of considering Phonological aspects in the analysis of disordered Prosody and the need for careful assessment of the appropriacy of the compensatory strategies that have been developed.