Dysarthria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Dysarthria is a speech disorder resulting from neurological injury, characterised by poor articulation (cf aphasia: disorder of the content of speech). Any of the speech subsystems (respiration, phonation, resonance, prosody, articulation and movements of jaw and tongue) can be affected.

Disarthic speech is due to some disorder in the nervous system, which in turn hinders control over for example tongue, throat, lips or lungs. Swallowing problems, dysphagia, are often present.

Cranial nerves that control these muscles include the facial nerve (VII), the glossopharyngeal nerve (IX), the vagus nerve (X), and the hypoglossal nerve (XII).

Classification

• Dysarthria may be classified according to presentation of symptoms into the following:

Type of Dysarthria	Main Feature
Flaccid	bilateral or unilateral damage to the lower motor neuron
Spastic	bilateral damage to the upper motor neuron
Ataxic	damage to cerebellum
Hyper-kinetic	damage to parts of the basal ganglia
Hypokinetic	damage to parts of the basal ganglia
Mixed	more than one type of dysarthria are present

Pathophysiology

The reasons behind dysarthria can be many; among the diseases are ALS, Parkinson's disease, botulism, cranial nerve lesions, chorea, prion protein related diseases, and cerebral palsy. Dysarthria can also be an early symptom of stroke, and of other forms of traumatic brain injury. More common causes are intoxication and anesthesia, although these are transient. Another possibility is myasthenia gravis.

Causes

Common Causes

• Amyotrophic lateral sclerosis
• Botulism
• Brain injury
• Brain tumor
• Cerebral palsy
• Huntington's disease
• Multiple sclerosis
• Myasthenia gravis
• Parkinsonism
• Stroke
• Wilson's disease

Causes by Organ System

Cardiovascular	Amyloidosis, Basilar artery insufficiency, Brainstem infarction , Brainstem stroke, Cardiofaciocutaneous syndrome, Cerebellar infarction , Cerebral stroke , Cerebrovascular accident, Noonan syndrome, Stroke
Chemical/Poisoning	Anesthesia, Botulinum toxin, Manganese poisoning, Organophosphate poisoning
Dental	No underlying causes
Dermatologic	Dermatomyositis
Drug Side Effect	Asenapine maleate, Carbamazepine, Cytarabine, Lacosamide, Lomustine, Loxapine, Olanzapine, Oprelvekin, Perphenazine, Pramipexole
Ear Nose Throat	Enlarged tongue, Hearing loss, Macroglossia
Endocrine	Amyloidosis, Hypothyroidism, Maturational delay, Woodhouse-sakati syndrome
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	Charlevoix-saguenay spastic ataxia, Mitochondrial disease, Noonan syndrome, Progressive external ophthalmoplegia, autosomal recessive, Turner syndrome, Wilson's disease, Wolfram's disease, Woodhouse-sakati syndrome
Hematologic	No underlying causes
Iatrogenic	Anesthesia
Infectious Disease	Abscess, Anaerobic infection, Botulism, Diptheria, Guillain-barre syndrome, Lyme disease, Poliomyelitis
Musculoskeletal/Orthopedic	Muscular dystrophy, Myasthenia gravis, Myotonic muscular dystrophy, Polymyositis, Progressive external ophthalmoplegia, autosomal recessive
Neurologic	Acquired brain injury, Acute dystonic reaction, Alcoholic cerebellar degeneration, Amyotrophic lateral sclerosis, Anticonvulsant intoxication, Articulation disorders, Basal ganglia disorders, Basilar artery insufficiency, Botulism, Brain injury, Brain tumor, Brainstem infarction , Brainstem tumor, Brainstem stroke, Central pontine myelinosis, Cerebellar disorders, Cerebellar infarction , Cerebellar syndrome, Cerebral palsy, Cerebral stroke , Cerebrovascular accident, Charlevoix-saguenay spastic ataxia, Degenerative brain disease, Dementia, Dermatomyositis, Diabetic nerve infarction, Friedreich's ataxia, Guillain-barre syndrome, Hearing loss, Huntington's disease, Motor neurone disease, Multiple sclerosis, Muscular dystrophy, Myasthenia gravis, Myotonic muscular dystrophy, Neuroferritinopathy, Neuron lesions of cranial nerve ix, Neuron lesions of cranial nerve x, Olivopontocerebellar degeneration, Parkinson disease, Parkinsonism, Parkinson's disease, Partington x-linked mental retardation syndrome, Phonology disorders, Progressive supranuclear palsy, Resonance disorders, Spinocerebellar ataxias, Wilson's disease, Worster-drought syndrome
Nutritional/Metabolic	Diabetic nerve infarction, Neuroferritinopathy
Obstetric/Gynecologic	No underlying causes
Oncologic	Brain tumor, Brainstem tumor
Ophthalmologic	No underlying causes
Overdose/Toxicity	Alcoholic cerebellar degeneration, Anticonvulsant intoxication
Psychiatric	Psychologic disorders
Pulmonary	No underlying causes
Renal/Electrolyte	Central pontine myelinosis
Rheumatology/Immunology/Allergy	Amyloidosis, Polymyositis
Sexual	No underlying causes
Trauma	Abscess, Head injury, Head trauma, Hearing loss, Poorly fitting mouth appliances
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

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Treatment

The articulation problems that dysarthria causes can be treated together with a speech language pathologist using a range of techniques which sometimes includes strengthening the speech musculature. Devices that make coping with dysarthria easier include speech synthesis software and text-based telephones.