A review on approach to a twitchy tongue in neurology

Salari, Mehri; Rezaei, Kamran; Mirdehghan, A; Behzadi, Arya; Etemadifar, Masoud

doi:10.1007/s10072-023-06771-3

Cited by 3 publications

(1 citation statement)

References 96 publications

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“…Tongue deviation could be due to dystonia but can also be seen in tongue weakness or structural abnormalities. 69,70 However, in our patients with tongue deviation (N=10), there were no structural changes or tongue atrophy, and the tongue deviation improved as the flare resolved. Overflow movements are involuntary posturing in body regions outside of the area of intentional movement and may be secondary to pathology in the basal ganglia, cerebellum, and sensorimotor cortex.…”

Section: Discussionmentioning

confidence: 59%

Prevalence of Neurological Soft Signs at Presentation in Pediatric Acute-Onset Neuropsychiatric Syndrome

Zebrack,

Gao,

Verhey

et al. 2024

Preprint

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Importance: Studies of brain imaging and movements during REM sleep indicate basal ganglia involvement in pediatric acute-onset neuropsychiatric syndrome (PANS). Characterizing neurological findings commonly present in patients with PANS could improve diagnostic accuracy. Objective: To determine the prevalence of neurological soft signs which may reflect basal ganglia dysfunction (NSS-BG) in youth presenting with PANS and whether clinical characteristics of PANS correlate with NSS-BG. Design, Setting, and Participants: 135 new patients who were evaluated at the Stanford Children's Immune Behavioral Health Clinic between November 1, 2014 and March 1, 2020 and met strict PANS criteria were retrospectively reviewed for study inclusion. 16 patients were excluded because they had no neurological exam within the first three visits and within three months of clinical presentation. Main Outcomes and Measures: The following NSS-BG were recorded from medical record review: 1) glabellar tap reflex, 2) tongue movements, 3) milkmaid's grip, 4) choreiform movements, 5) spooning, and 6) overflow movements. We included data from prospectively collected symptoms and impairment scales. Results: The study included 119 patients: mean age at PANS onset was 8.2 years, mean age at initial presentation was 10.4 years, 55.5% were male, and 73.9% were non-Hispanic White. At least one NSS-BG was observed in 95/119 patients (79.8%). Patients had 2.1 NSS-BG on average. Patients with 4 or more NSS-BG had higher scores of global impairment (p=0.052) and more symptoms (p=0.008) than patients with 0 NSS-BG. There was no significant difference in age at visit or reported caregiver burden. On Poisson and linear regression, the number of NSS-BG was associated with global impairment (2.857, 95% CI: 0.092-5.622, p=0.045) and the number of symptoms (1.049, 95% CI: 1.018-1.082, p=0.002), but not age or duration of PANS at presentation. Conclusions and Relevance: We found a high prevalence of NSS-BG in patients with PANS and an association between NSS-BG and disease severity that is not attributable to younger age. PANS may have a unique NSS-BG profile, suggesting that targeted neurological exams may support PANS diagnosis.

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Section: Discussionmentioning

confidence: 59%

Prevalence of Neurological Soft Signs at Presentation in Pediatric Acute-Onset Neuropsychiatric Syndrome

Zebrack,

Gao,

Verhey

et al. 2024

Preprint

View full text Add to dashboard Cite

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Lingual Seizures in a Four-Year-and-Eight-Month-Old Boy

Koul,

Alam,

Khanna

2024

Journal of Pediatric Epilepsy

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Lingual seizures (LS) mean isolated seizures of the tongue. They are uncommon, and only a few cases have been reported. Sensory, motor, and autonomic auras or focal manifestations have a localizing value in seizures. LS have been reported with and without focal pathology in the brain. LS must be differentiated from more common conditions, like lingual tremors/dyskinesias. We report a 4-year-and-8-month-old boy with LS.

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Cerebellar control of targeted tongue movements

Bina,

Ciapponi,

et al. 2024

Preprint

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The cerebellum is critical for coordinating movements related to eating, drinking and swallowing. Cerebellar Purkinje cell activity has been shown to encode ongoing tongue movements, but it is unclear how this activity can alter the trajectory of the tongue. To elucidate the impact of Purkinje cells on goal-directed tongue movements, we recorded their activity in the vermis and hemispheres during spontaneous licking from a stationary or moving water spout. Some Purkinje cells encode rhythmic tongue movements with their complex spikes, others with their simple spikes or a combination of both. Complex spikes predominantly marked the start and end of a licking bout, and thus encoded behavioural state changes, while simple spike firing was more related to individual licks. In addition, complex spikes reported unexpected changes in the position of the water spout and subsequent modulation of simple spike firing caused bending of the tongue, reaching out for the new target position. Using machine learning, we demonstrated that it is possible to predict licking activity based on the spiking patterns of individual Purkinje cells. Using optogenetic stimulation of Purkinje cells, we could experimentally replicate the impact of modulated simple spike firing, suggesting that increased simple spike activity indeed causes ipsilateral bending of the tongue during goal-directed movements. Our data highlight that directional control of movements is paramount in cerebellar function and that complex spike and simple spike modulation complement each other during sensorimotor coordination. These results bring us closer to understanding clinical implications of cerebellar disorders during eating, drinking and swallowing.

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A review on approach to a twitchy tongue in neurology

Cited by 3 publications

References 96 publications

Prevalence of Neurological Soft Signs at Presentation in Pediatric Acute-Onset Neuropsychiatric Syndrome

Prevalence of Neurological Soft Signs at Presentation in Pediatric Acute-Onset Neuropsychiatric Syndrome

Lingual Seizures in a Four-Year-and-Eight-Month-Old Boy

Cerebellar control of targeted tongue movements

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