Speech Problems

WHEN TO SEE YOUR DOCTOR

* Your speech problems show up after an accident or head injury.

* See your doctor immediately if your speech suddenly becomes garbled, slurred, thickened or unclear.

* See your doctor immediately if you suddenly begin to repeat words or phrases over and over or if your words continue to come out wrong even though you know what you intend to say.

* See your doctor immediately if you can't speak at all for several minutes, even though you recover the ability later.

What Your Symptom Is Telling You

We all know what it's like to grope for a word now and then. You know what you want to say—you can almost see that word—but it just hangs there on the tip of your tongue.

Speech is the most complex function of the human brain, says Daniel Zwitman, Ph.D., a Los Angeles speech pathologist with expertise in neurological dysfunction. "In order to just say 'ahhh,' 76 muscles have to work in unison," he explains. "With all the interrelationships in communication, it's easy to see how it can break down."

What can break down the ease of speech? Anything that injures the brain or the nerves controlling speech can create difficulty in finding words or in simply "getting out" what you want to say.

Garbled speech could, for example, signal a stroke or a transient ischemic attack (TIA). TIA, also known as a mini-stroke, is a warning that a full-blown stroke could happen in the near future. During a TIA, spasming blood vessels can clamp down hard enough to temporarily cut off blood flow to the brain's speech command center.

A migraine headache is a milder form of TIA. During a migraine, you can experience a brief moment of aphasia—difficulty expressing thoughts and understanding spoken and written words.

Any injury, tumor or slowly debilitating neurological disorder or disease can damage the parts of the brain that control speech and disturb the smooth flow of words. With some conditions, such as Parkinson's disease, speech might become unintelligible—either very slow or excessively fast and repetitive.

Speech problems vary greatly, and the specific kind of difficulty you have in speaking helps experts determine where in the brain the problem lies. Normally, doctors say, if your speech problems come on suddenly, they are most likely the result of a stroke. If the process has been gradual, a neurological problem or disease is more likely to be the cause.

There are simpler causes for speech problems, too. The kind of momentary lapse that we all experience now and then ("Darn it, what is that word?") is perfectly normal. It might be ordinary forgetfulness.

Symptom Relief

When speech problems appear suddenly, don't delay. Get medical help immediately. If you are having a stroke, quick treatment will make a great deal of difference in your recovery. Here are a few other things to be aware of.

Treat neurological conditions. Speech symptoms from some diseases of the brain or nervous system may respond to medication, says Charles Diggs, Ph.D., director of consumer affairs for the American Speech-Language-Hearing Association in Rockville, Maryland. Parkinson's disease, for example, is often treated with drugs such as Larodopa, which is derived from dopamine, a brain chemical found to be in diminishing supply in those with the disease.

Ease a migraine. If you routinely experience migraine headaches, your doctor can prescribe ergotamine to take as soon as you feel the headache coming on, says Austin King, M.D., an otolaryngologist in Abilene, Texas. Severe migraines may be prevented with beta blockers or calcium channel agonists, he says. (For other ways to deal with migraines, see Headaches on page 234.)

Ask about speech therapy. If you've had a stroke or head trauma that effects your ability to communicate, speech therapy can help to facilitate the return of your language or your ability to speak more clearly. "The earlier you begin therapy, the better the probability you will overcome depression and get faster return of your ability to communicate," says Betty Horwitz, Ed.D., a speech pathologist in private practice in New York City.