This past October, actor Selma Blair revealed that what she had originally thought was an issue with a pinched nerve was actually multiple sclerosis (MS). Now, in her first televised interview since she received her diagnosis, Blair said that she also developed spasmodic dysphonia, a neurological vocal condition.
"Ever since my son was born, I was in an MS flare-up and didn't know, and I was giving it everything to seem normal," Blair said in an interview with Good Morning America on Tuesday. She also explained that she experienced chronic pain for years and "self-medicated" and drank alcohol to deal with it. (Blair celebrated two years of sobriety in June 2018.)
But once she finally received her diagnosis, Blair cried. "They weren't tears of panic, they were tears of knowing I now had to give in to a body that had loss of control, and there was some relief in that," she explained. She added that she was "very happy" to be able to do the interview and "put out what being in the middle of an aggressive form of multiple sclerosis is like."
Blair also acknowledged that her voice was different and noticeably shaky, a change that she attributed to a condition called spasmodic dysphonia.
Spasmodic dysphonia is a condition affecting the muscles of the larynx.
You have two vocal folds (or cords), which are thin sheets of muscular tissue extending from either side of your larynx (voice box) and attach on one end, Lee Akst, M.D., director of the Johns Hopkins Voice Center, tells SELF. When they're open, they form a V shape. When you speak, muscles push them close together so that they touch lightly and air coming up from your lungs pushes them apart. The vibrations created in that process form the basis of your voice, Dr. Akst explains.
But in the most common type of spasmodic dysphonia, the neurological signal that coordinates that muscle contraction causes spasms that push the vocal folds together too tightly—to the point that air can't get through, Dr. Akst says. That causes a specific speech pattern marked by a strained choppiness (referred to as "staccato breaks").
Although spasmodic dysphonia can come on suddenly, those who experience a more gradual progression tend to feel like it first takes more effort to speak, which might result in some raspiness or roughness. Eventually that develops to the classic staccato pattern of speaking, in which speech abruptly stops and starts again. (There are other types of spasmodic dysphonia that cause the vocal cords to stay open rather than closed or that can cause them to stay open or closed, but these are rarer, according to the National Institutes of Health (NIH).)
The exact cause of spasmodic dysphonia isn't totally understood. But the current thinking is that abnormal functioning of neurotransmitters in the basal ganglia—the part of the brain that's responsible for coordinating involuntary movements, including those involved in speech and swallowing—is the physiological root of the condition, the NIH explains.
Symptoms of spasmodic dysphonia can come on gradually for unknown reasons, or they may come on suddenly as a result of another issue, such as an upper respiratory infection, intubation during surgery, or some sort of trauma in the vocal cord area, Dr. Akst says. However, whether or not those types of events are directly responsible for the condition isn't always clear.
Genetics may also play a role in some cases, the NIH says.
Vocal changes like this are actually somewhat rare in MS.
"MS is an autoimmune disease where the immune system attacks the nervous system—the brain, the spinal cord, the optic nerves," Robert Bermel, M.D., a neurologist in the Mellen Center for Multiple Sclerosis at Cleveland Clinic, tells SELF. "And the symptoms that a patient has are directly related to where in the nervous system the attacks occur."
So, technically, spasmodic dysphonia is a condition that occurs by itself, not as a result of another condition like MS, Dr. Akst says. But if a patient with MS does exhibit vocal changes characteristic of spasmodic dysphonia, that suggests "the MS is affecting the same part of the brain" that's at the root of spasmodic dysphonia, Dr. Akst explains, referring to the basal ganglia.
People that have MS lesions in other parts of their brain, like the cerebellum, may show other types of vocal changes, Dr. Bermel says, such as not being able to land on the right pitch or a voice that sounds like it's fluctuating a lot, which are characteristic of a neurological symptom called ataxia. Dr. Akst says he might expect to see an overall weakening of projection, changes in pronunciation or pacing, or an overall thin, reedy quality in the voices of patients with MS.
Diagnosing these conditions requires careful listening to these different qualities and usually a stroboscopy, a procedure in which a camera is inserted through the patient's nose to check on the vocal cords and rule out other conditions that could be responsible for the changes (like polyps). It also requires looking at the full picture of their symptoms, Dr. Bermel says. If someone has a vocal issue alongside muscle weakness or changes in vision, for instance, that's an indicator that they may be dealing with an underlying neurological condition like MS.
Treatment focuses on managing the symptoms.
Treatment for spasmodic dysphonia doesn't cure the condition, it can really only address the symptoms. Some patients with spasmodic dysphonia have success with voice therapy, which helps them develop compensatory strategies but doesn't address the underlying physiological issue, Dr. Akst says. Other patients may opt for Botox injections into the vocal cord (through the neck), which weakens the muscles and prevents them from spasming so tightly. (If Botox injections do help a patient, that's even more confirmation that the diagnosis is correct, Dr. Akst notes.)
If spasmodic dysphonia is associated with MS, medications to manage spasms throughout the body, such as muscle relaxants, may also help with spasmodic dysphonia, Dr. Bermel says. In these cases, patients may find that their vocal changes worsen with a flare-up and then get better, like many symptoms of MS.
Above all, getting a correct diagnosis and a treatment plan for your individual case is crucial. Because MS can present in so many different ways, it's important to have "a personalized approach to each person’s disease," Dr. Bermel says.