speech and eye problems

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Dysarthria happens when the muscles used for speech are weak or are hard to control. Dysarthria often causes slurred or slow speech that can be difficult to understand.

Common causes of dysarthria include conditions that affect the nervous system or that cause facial paralysis. These conditions may cause tongue or throat muscle weakness. Certain medicines also can cause dysarthria.

Treating the underlying cause of dysarthria may improve your speech. You also may need speech therapy. For dysarthria caused by prescription medicines, changing or stopping the medicines may help.

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Symptoms of dysarthria depend on the underlying cause and the type of dysarthria.

Symptoms may include:

• Slurred speech.
• Slow speech.
• Not being able to speak louder than a whisper or speaking too loudly.
• Rapid speech that is difficult to understand.
• Nasal, raspy or strained voice.
• Uneven speech rhythm.
• Uneven speech volume.
• Monotone speech.
• Trouble moving your tongue or facial muscles.

When to see a doctor

Dysarthria can be a sign of a serious condition. See a healthcare professional right away if you have sudden or unexplained changes in your ability to speak.

Dysarthria can be caused by conditions that make it hard to move the muscles in the mouth, face or upper respiratory system. These muscles control speech.

Conditions that may lead to dysarthria include:

• Amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig's disease.
• Brain injury.
• Brain tumor.
• Cerebral palsy.
• Guillain-Barre syndrome.
• Head injury.
• Huntington's disease.
• Lyme disease.
• Multiple sclerosis.
• Muscular dystrophy.
• Myasthenia gravis.
• Parkinson's disease.
• Wilson's disease.

Some medicines also can cause dysarthria. These may include certain sedatives and seizure medicines.

Risk factors

Dysarthria risk factors include having a neurological condition that affects the muscles that control speech.

Complications

Complications of dysarthria may come from having trouble with communication. Complications may include:

• Trouble socializing. Communication problems may affect your relationships with family and friends. These problems also may make social situations challenging.
• Depression. In some people, dysarthria may lead to social isolation and depression.
• Jankovic J, et al., eds. Dysarthria and apraxia of speech. In: Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed March 27, 2024.
• Dysarthria. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/dysarthria/. Accessed April 6, 2020.
• Maitin IB, et al., eds. Current Diagnosis & Treatment: Physical Medicine & Rehabilitation. McGraw-Hill Education; 2020. https://accessmedicine.mhmedical.com. Accessed April 10, 2020.
• Dysarthria in adults. American Speech-Language-Hearing Association. https://www.asha.org/practice-portal/clinical-topics/dysarthria-in-adults/. Accessed March 27, 2024.
• Drugs possibly associated with dysarthria. IBM Micromedex. https://www.micromedexsolutions.com. Accessed April 4, 2024.
• Lirani-Silva C, et al. Dysarthria and quality of life in neurologically healthy elderly and patients with Parkinson's disease. CoDAS. 2015; doi:10.1590/2317-1782/20152014083.
• Signs and symptoms of untreated Lyme disease. Centers for Disease Control and Prevention. https://www.cdc.gov/lyme/signs_symptoms/index.html. Accessed March 27, 2024.
• Neurological diagnostic tests and procedures. National Institute of Neurological Disorders and Stroke. https://catalog.ninds.nih.gov/publications/neurological-diagnostic-tests-and-procedures. Accessed March 27, 2024.

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• Slurred Speech

6 Causes of Slurred Speech

• Most common questions

What is slurred speech?

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6 most common cause(s)

Slurred speech is when you have trouble speaking, your words are slow or garbled, or your words run together. When you talk, many components of your nervous system work together to form words. When these parts don’t work correctly, your speech can become distorted, or “slurred.” The medical term for slurred speech is dysarthria.

Slurred speech includes problems pronouncing words and regulating the speed or pace of your speech. It can range from a barely noticeable problem to one that’s so severe that others can’t understand what you’re saying.

People often describe slurred speech as feeling like you’re trying to talk with your mouth full of marbles.

Common causes of slurred or slow speech include drinking too much alcohol and not getting enough sleep. In these cases, the slurring will stop once you’re sober again and have gotten rest, respectively.

There are also other causes of slurred speech such as a stroke (a medical emergency), brain tumor, Bell’s palsy, or a serious migraine.

Does slurred speech always need to be treated?

"People often think slurred speech is a minor symptom that does not need a medical evaluation. As our speech and ability to speak is our main form of communication, it is important to look for correctable causes." — Dr. Karen Hoerst

Should I go to the ER for slurred speech?

You should call 911 if:

• Your slurred speech starts suddenly.
• You have other symptoms, such as a sudden or severe headache and weakness or numbness of one side of your body.
• Your tongue, face, or lips are swelling, which could mean you’re having an allergic reaction.

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1. Stroke or TIA (transient ischemic attack)

• Slurred speech
• Drooping of one side of the face
• Weakness or trouble controlling one side of the body
• Numbness in the face , arm , or leg
• Difficulty walking
• Sudden loss of vision or double vision
• Sudden, severe headache

A stroke occurs in the brain because the blow flow in a blood vessel is blocked. It can also happen when a blood vessel ruptures or leaks. This affects the blood supply to parts of the brain, which leads long-term damage. If it affects the area of the brain responsible for speech, it can cause slurred speech.

A transient ischemic attack , or TIA, is sometimes called a "mini stroke." A TIA is a temporary interruption of blood flow that causes the same symptoms as a stroke, but improves without any permanent damage to the brain or symptoms.

For example, if you have slurred speech because of a TIA, once the blood flow is restored to that area of the brain, the slurred speech goes away. But people who have a TIA are at a high risk of having a stroke in the future, especially if their risk factors are not treated. Risk factors are the same for stroke and TIA and include smoking, obesity, and cardiovascular disease.

It’s extremely important to call 911 right away if you suddenly have slurred speech. Getting immediate treatment is critical to minimizing permanent damage. Paramedics can begin treating you in the ambulance on the way to the hospital, so it’s better to call 911 than go to the ER yourself.

Treatments for strokes and TIAs include medications to break up blood clots and surgery to remove blood clots from the vessels. If your stroke is from bleeding in the brain, you may need surgery to repair a blood vessel.

Following treatment, your doctor will recommend medications to prevent another TIA or stroke. These typically include drugs that prevent clots from forming in the blood (like aspirin or other blood thinners) and cholesterol medication to prevent plaque from building up on the walls of the blood vessels. You may also need to take medication to control your blood pressure.

Speech therapy is recommended to help treat problems with speech.

It may not be a stroke

"There are so many possible causes of slurred speech. Most of the time we need a detailed history and physical exam to guide the diagnosis and treatment." — Dr. Hoerst

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2. Bell’s palsy

• Drooping of the face
• Drooping of the eye
• Changes in taste or hearing

Bell’s palsy is a relatively common condition that affects the facial nerve, which is responsible for movement of your face.

In Bell’s palsy, the nerve gets inflamed typically because of a recent viral infection. This inflammation can cause the facial nerve to not work as well, leading to drooping and slurred speech.

Bell’s palsy usually improves in a few months, but medications such as steroids and antiviral drugs are typically given to help speed the process. If nerve problems continue, physical therapy is recommended. In rare instances, surgery may be needed to help improve facial muscle function.

3. Brain tumor

• Slurred speech or speech difficulties
• New or changing headaches
• Weakness or coordination and balance problems
• Abnormal vision

A brain tumor is an abnormal growth of cells in the brain. A brain tumor may be cancerous (malignant) or noncancerous (benign). Both types can cause symptoms including slurred speech.

The diagnosis of a tumor in the brain or spinal cord is based on an exam and imaging of the brain, such as an MRI or CT scan. A biopsy (tissue sample) may be needed to determine what type of tumor it is.

Some tumors, such as a small noncancerous tumor, do not need treatment, though your doctor will recommend periodic MRI scans to make sure it hasn’t changed.

Most larger or cancerous tumors do require treatment, which may consist of chemotherapy, radiation, or surgery. If you develop physical or cognitive (mental) problems from the tumor, rehabilitation such as physical therapy, occupational therapy, or speech therapy may be needed.

4. Multiple sclerosis

• Blurred vision or decreased vision, typically in one eye
• Weakness or trouble walking
• Numbness or pins-and-needles sensation on your face, arm, or leg (typically on one side)
• A band-like squeezing sensation around the chest or abdomen
• Difficulty focusing

Multiple sclerosis, or MS, is a central-nervous system disease that affects the cells of the brain and spinal cord. In MS, a fatty tissue that surrounds nerve fibers (myelin) is attacked. Myelin helps to insulate the electrical signals sent through the nerves. When there is a problem with this fatty tissue, information sent to and from the brain can be disrupted.

MS is most common in young adults between the ages of 20 and 50, according to the National MS Society .

MS is not curable , but treatments have dramatically improved the ability to control MS, so people usually have fewer symptoms and less disability.

Treatment includes medications that may be taken orally or injected or infused through an IV line. Physical therapy and speech therapy are commonly used to help in physical recovery, and medications can be used to treat other symptoms, such as depression, pain, and fatigue.

5. Amyotrophic lateral sclerosis (ALS)

• Difficulty with speech, including slurred speech
• Progressive weakness and difficulty balancing
• Muscle cramps, twitching, and stiffness
• Difficulty swallowing

Amyotrophic lateral sclerosis (ALS) is also known as Lou Gehrig’s disease. It affects nerve cells called motor neurons that control your movement.

The disease primarily causes a loss of strength, impaired swallowing and speech, and in most cases, difficulty breathing because of impaired respiratory muscles. It is a progressive disease, meaning that symptoms are mild at first and worsen over time.

Previously, it was thought that ALS doesn’t affect a person’s mental ability. But it’s now known that people with ALS can get a specific type of dementia called frontotemporal dementia (FTD). That condition can affect behavior, mood, and speech.

Symptoms of ALS can develop in adults of any age, but it’s most commonly diagnosed in people who are between the ages of 40 and 70, according to the ALS Association .

While there are some medications that can be used to delay the progression of the disease, there is currently no cure for ALS. Treatment includes rehabilitation with physical therapy, occupational therapy, speech therapy, and respiratory therapy.

6. Migraine

• Sensitivity to light and sound
• Visual disturbances

A migraine causes a severe headache that is often accompanied by nausea and sensitivity to light or sound. But some migraines don’t cause head pain.

Other symptoms that involve the nervous system can occur. Some of these sensory symptoms are called “auras.” These distortions can cause visual changes , including flashing lights or distorted vision. People may feel tingling or numbness of their face, arm, or leg.

In some types of migraine, people may even develop slurred speech and weakness of the face, arm, or leg. These are also symptoms of a stroke, so it may be hard to figure out which condition you have. If you develop sudden slurred speech or weakness, go to the ER immediately.

In an acute migraine attack, medications can be used to stop a migraine that has already started, such as triptans or newer medications called CGRP inhibitors. These medications can be in pill form, inhaled form, or injectable medications.

Migraine prevention can include taking medications for blood pressure, anticonvulsants, or even antidepressants. In some instances, Botox treatments are used to prevent migraine.

Behavior and lifestyle changes such as exercise, improved sleep, and healthy diet or weight loss are also often recommended to help decrease the number of migraine headaches you experience.

Other possible causes

Slurred speech may occur from alcohol intoxication or tiredness. It can also be a side effect of medications like high dose pain medications, antipsychotic medications or even some allergy medications like antihistamines. Other causes include:

• Infections such as urinary tract infections or electrolyte imbalances (particularly in elderly people).
• Brain infections such as meningitis or encephalitis.
• Problems that affect your mouth or throat, such as poorly fitting dentures, dental infections, dental numbing medications, swelling in your throat, or muscle or nerve problems.
• An allergic reaction , especially if you notice slurred speech along with tongue swelling , lip swelling, or shortness of breath.

"Early speech therapy can not only help with early improvement but also with diagnosis. Speech-language pathologists have special training in detecting the various types of slurred speech, which helps to determine the possible causes."— Dr. Hoerst

Specialty treatment options

• Speech therapy is the most common treatment for slurred speech.
• Injected medications such as Botox are sometimes used, depending on the cause of slurred speech.
• Medications to improve nerve and muscle function.

While it's important to follow your healthcare provider's guidance, here are some over-the-counter (OTC) options that might provide extra support.

• Proper nutrition supports overall health, including nerve function. Supplements like B vitamins may support neurological health.
• Staying hydrated is key, especially if speech difficulties make it hard to drink. Consider a no-spill, easy-sip water bottle designed for easy grip.
• Engaging in exercises to improve speech clarity can be helpful. Explore speech therapy tools and resources that you can use at home.

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What Is Dysarthria?

Dysarthria is a condition in which the part of your brain that controls your lips, tongue, vocal cords, and diaphragm doesn't work well. It's hard for you to move those muscles the right way.

This condition comes in two forms:

• Developmental dysarthria happens from damage to a growing baby's brain in the womb or at birth. Cerebral palsy is one possible cause. Developmental dysarthria affects children.
• Acquired dysarthria happens from damage to the brain later in life. A stroke, Parkinson's disease, or a brain tumor is the possible cause. This type affects adults.

People with dysarthria can think and understand language. But they have trouble talking because of weakness in the muscles that control speech .

Some people with dysarthria have only minor speech problems. Others have so much trouble getting their words out that other people may not be able to understand them very well. A speech-language therapist can help improve speaking skills.

Types of Dysarthria

The six types of dysarthria are divided by causes or symptoms. They include:

• Spastic dysarthria is caused by damage to nerve cells in the central nervous system that affect movement. It makes the voice sound harsh.
• Hypokinetic dysarthria happens from damage to a part of the brain called the basal ganglia that controls movement. Speech is slow and never changes pitch.
• Hyperkinetic dysarthria  is also from damage to the basal ganglia . In this case, speech is fast and changes a lot.
• Ataxic dysarthria happens from damage to the cerebellum, a part of the brain that helps muscles move. It can cause problems in the way you pronounce words.
• Flaccid dysarthria affects the lower motor neurons that send signals to your muscles to move. Your speech may sound nasal.
• Mixed dysarthria is the most common type. It's a mixture of other types, such as spastic plus flaccid.

Causes of Dysarthria

Damage to the parts of the brain that control speech causes dysarthria. Any of these conditions can cause this type of damage:

• Amyotrophic lateral sclerosis (ALS) or Lou Gehrig's disease
• Brain tumors
• Cerebral palsy
• Guillain-Barre syndrome
• Huntington's disease
• Lyme disease
• Multiple sclerosis (MS)
• Muscular dystrophy
• Myasthenia gravis
• Parkinson's disease
• Side effects of certain medicines, such as epilepsy drugs
• Traumatic brain injury
• Wilson's disease

Prevalence of dysarthria

The likelihood of getting dysarthria depends on the cause. This condition affects:

• 30% of people with ALS
• 25%-50% of people with MS
• 70%-100% of those with Parkinson's disease
• 8%-60% of people who have had a stroke
• 10%-65% of those with traumatic brain injury

Dysarthria Symptoms

Depending on the cause, dysarthria can make your speech:

• Have an uneven rhythm
• Higher- or lower-pitched than usual
• Nasal or whiny
• Slow or fast
• Soft like a whisper

Because dysarthria can make it harder to move your lips, tongue , and jaw, it can be harder for you to chew and swallow. Trouble swallowing can cause you to drool.

Dysarthria Diagnosis

If you suddenly have a hard time speaking, you might be having a stroke. Call 911 right away. But if it's been happening for a while, see a speech-language pathologist (SLP) . They'll ask about any diseases you have that could affect your speech.

They'll also want to check the strength of the muscles in your lips, tongue, and jaw as you talk. They might ask you to:

• Stick out your tongue
• Make different sounds
• Read a few sentences
• Count numbers
• Blow out a candle

Tests for dysarthria

You might need some tests , including:

• Imaging tests like MRI or CT scans
• Blood or urine tests
• Brain and nerve tests like electroencephalogram or electromyography
• Spinal tap to check for infection
• Swallowing study to check for problems when you swallow

Dysarthria Treatment

Treatment will depend on the cause of your dysarthria, the type, and your symptoms. Your speech might get better after you treat the cause.

If you still have dysarthria, you might see a SLP who will teach you:

• Exercises to strengthen the muscles of your mouth and jaw
• Ways to speak more clearly, such as talking more slowly or pausing to catch your breath
• How to control your breath to make your voice louder
• How to use devices like an amplifier to improve the sound of your voice

Your therapist also will give you tips to help you communicate, such as:

• Carry a notebook or smartphone with you. If someone doesn't understand you, write or type what you want to say.
• Make sure you have the other person's attention.
• Speak slowly.
• Talk face-to-face if you can. The other person will be able to understand you better if they can see your mouth move.
• Try not to talk in noisy places, like at a restaurant or party. Before you speak, turn down music or the TV or go outside.
• Use facial expressions or hand gestures to get your point across.
• Use short phrases and words that are easier for you to say.

Tips for Friends and Family of People With Dysarthria

Your therapist will work with your family to help them understand you better. They may suggest that your loved ones:

• Ask if they don't understand something
• Give you time to finish what you have to say
• Look at you when they talk with you
• Repeat the part they understood so you don't have to say the whole thing again
• Try not to finish your sentences for you
• Talk to you as they would with anyone else
• Continue to involve you in conversation

Dysarthria Complications

Dysarthria can affect many parts of your life. When you have trouble speaking clearly, you may be less able to communicate with loved ones. This can affect your relationships with family and friends.

It's common for people with dysarthria to feel alone and depressed. That's why it's so important to get treatment from a speech-language therapist and see a mental health professional if you feel alone or sad.

Dysarthria is a problem with parts of your nervous system that affects speech. It comes in several types that each affect speech in different ways. In speech therapy, you can learn exercises and tips to help you communicate more easily.

Dysarthria FAQs

What is the main cause of dysarthria?

Damage to the brain from a condition like Parkinson's disease, a stroke, an injury , or MS can cause dysarthria.

How do people with dysarthria speak?

How speech changes depends on the type of dysarthria. The voice might sound breathy, nasal, slurred, fast, slow, out of rhythm, very loud, or very quiet.

What is an example of dysarthria speech?

Someone with dysarthria may speak slowly, haltingly, and at the same pitch (monotone).

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Dysarthria (difficulty speaking)

Dysarthria is where you have difficulty speaking because the muscles you use for speech are weak. It can be caused by conditions that damage your brain or nerves and some medicines. Speech and language therapy can help.

Immediate action required: Call 999 if:

• somebody's face droops on 1 side (the mouth or eye may have drooped)
• a person cannot lift up both arms and keep them there
• a person has difficulty speaking (speech may be slurred or garbled)

These can be signs of a stroke, which is a medical emergency. The symptoms of a stroke usually come on suddenly.

Do not drive yourself to A&E.

The person you speak to at 999 will give you advice about what to do.

Check if it's dysarthria

The main symptom of dysarthria is unclear speech. This can make it difficult for you to make yourself understood.

Your speech may only be slightly unclear, or you may not be able to speak clearly at all.

Other symptoms include:

• difficulty moving your mouth, tongue or lips
• slurred or slow speech
• difficulty controlling the volume of your voice, making you talk too loudly or quietly
• a change in your voice, making it nasal, strained or monotone
• hesitating a lot when talking, or speaking in short bursts instead of full sentences

Being stressed or tired may make your symptoms worse.

Dysarthria is not the same as dysphasia, although you can have both conditions at the same time. Dysphasia, also known as aphasia , is where you have difficulty understanding words or putting them together in a sentence.

Non-urgent advice: See a GP if:

• you've noticed gradual changes to your or your child's speech and you're worried

They'll examine you and may refer you to a specialist for further tests.

Causes of dysarthria

Dysarthria is usually caused by damage to the brain or conditions that affect the nervous system. It can happen at any age.

Common causes include:

• stroke , severe head injury and brain tumours
• Parkinson's disease , multiple sclerosis and motor neurone disease
• cerebral palsy and Down's syndrome

It can also be a side effect of certain medicines, such as some medicines to treat epilepsy.

Treatment for dysarthria

If you have dysarthria, you'll usually be referred to a speech and language therapist. They'll offer therapy to help your speech and communication.

The therapy you're offered will be different depending on the cause of your dysarthria and how severe it is.

Some people may find therapy does not help their symptoms, or their speech may get worse as their condition progresses. Their therapy may focus on helping communication in other ways.

Speech and language therapy may include:

• exercises to strengthen the muscles used for speech
• strategies to make your speech easier to understand, such as slowing down when you're talking
• using communication aids, such as an alphabet board or a voice amplifier

Find out more

• Headway: communication problems after brain injury
• Stroke Association: communication tools

Page last reviewed: 17 February 2023 Next review due: 17 February 2026