Calling on TwitchyDoc -- Tongue Fascics

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Calling on TwitchyDoc -- Tongue Fascics

Postby js1 on September 9th, 2013, 5:39 pm

I posted for the first time the other day, but wanted to do a video of my tongue twitches. I've been experiencing them since 2006, but in the past few months they seemed to have amped up slightly with my other symptoms. They are most present along the outer front edges of the tongue, and mostly after exertion. (More exertion makes the twitches crazier.) In the attached video, note the left side while the tongue is at rest in the mouth after exertion, and while protruded. When the tongue is protruded, I can assure you it is completely at rest. These "writhing" movements look more like weird spasms to me. TwitchyDoc, I ask you, are these true fasciculations/fibrillations? And, does there appears to be any atrophy on the tongue???

http://www.youtube.com/watch?v=L_Wj89KF ... e=youtu.be
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Re: Calling on TwitchyDoc -- Tongue Fascics

Postby js1 on September 9th, 2013, 11:04 pm

No responses. Does the Doc usually frequent a different part of the board?
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Re: Calling on TwitchyDoc -- Tongue Fascics

Postby Yuliasir on September 10th, 2013, 12:40 am

Instead of Doc I can tell you that protruded tongue is NEVER in rest because its main ligaments are strained. Tongue is at least two (if I did not mess up) big and very sensitive muscles which are hard to keep in rest becasue they are designed to move and react and make complicated movements.
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Re: Calling on TwitchyDoc -- Tongue Fascics

Postby js1 on September 10th, 2013, 12:47 am

Thanks, Yulisar. I have become quite good at relaxing the tongue because I bite down with my teeth to ensure no spontaneous movement, and these movements at the edge that you can see are, in fact, some type of twitch. You can see them also at rest inside the mouth if you look to the left after exertion. (it's just harder because I have such a fat tongue!) I'm just wondering if these "spasm" type movements are true fasciculations or something else. I know TwitchyDoc knows quite a bit about this stuff from looking at past posts, and was hoping he'd be able to weigh in. These seem to look something like the twitches Bobajojo posted a few months ago on video.

Again, I've had these "exertion" twitches for years, but they seem to have gotten more easily elicited in the past two months. Even if I swallow hard to clear my mouth of saliva, I tend to get them at the edges. This stuff is driving me mad.
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Re: Calling on TwitchyDoc -- Tongue Fascics

Postby Yuliasir on September 10th, 2013, 12:55 am

I think you'd better PM to Doc becasue he seems not to be a regular monitor as me myself :)

I had watched you movie and did not see anything sinister to be honest. really nice tongue, symmetrical, alive, etc.
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Re: Calling on TwitchyDoc -- Tongue Fascics

Postby bobajojo on September 10th, 2013, 5:34 am

My tongue does the same. I showed it to my neuro and he said that is consistent with neural hyperexciteability. Nothing to worry about. -Matt

http://www.youtube.com/watch?v=si_cdmwI8ms
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Re: Calling on TwitchyDoc -- Tongue Fascics

Postby TwitchyDoc on September 10th, 2013, 7:54 am

Hi js1!
I cannot see any fasciculations on the video (I will try to switch to HD if possible, I cannot do that here) and as for your tongue appearance - atrophy typically occurs from the tip and around the edges, producing wavy surface, your tongue looks normal to me. Also the uvula deviation seems to be in the normal physiological range.
As the others pointed out correctly, your tongue has to be resting completely (that is why some neurologists even refuse to do tongue EMG - it is extremely difficult to get correct reading), protruding it will lead to fasciculatory movement of some of the tongue muscles - remember tongue is not a muscle, it consists of a group of smaller interlaced muscles.
Also a side-note, what I see on Bobajojo's video - I would not classify that as fasciculations because it contracts and pulls which is the opposite of what a fasciculations is (brief asynchronous twitch of usually one motor unit). I would say it is hyperexcitable muscle fiber(s) but I remember Matt was saying he did get the regular twitches there, so probably it is just another phenomenon.
Anyway the best way to asses tongue fasciculations (at least the neurologist professors I know use it) is to protrude slightly, fastly move from one side to the other (this also checks the function) and then let it rest on the floor of the mouth. A flashlight is very helpful but hold it the way that the tongue surface will cast shadows (oblique).

I'm sure you have already seen that but still, that YT video of true fasciculations seems to be the best example:
http://www.youtube.com/watch?v=UsYkMPF3CTo

You can see there is no pulling etc., they are just fast, brief twitches you can barely notice.

Hope it helped!
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Re: Calling on TwitchyDoc -- Tongue Fascics

Postby bobajojo on September 10th, 2013, 8:05 am

I HATE that video. My tongue looks just like that with little fascics appearing on both sides, tip, way back... all over. I try not to look at my tongue anymore because they are always there but even when I'm not looking I can feel the little flickers. Happens all day, every day. But mine are benign so if you have anything like this, please do not panic. I've had fasciculations on my tongue for 2+ years now and I'm 100% fine.

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Re: Calling on TwitchyDoc -- Tongue Fascics

Postby chrissi on September 10th, 2013, 8:11 am

PLEASE do not use a flashlight on your tongue. NEVER. From all experiences on this forum, this is the 100% best way to cause you a MAYOR freakout. A huge one. Like your cry of agony in front of your mirror in the USA is so intense, that it makes the deer run out of the woods here in germany. Don't. Do.It.
Anyway, true tongue fascculations as well as tongue tremors, shakiness and pulling twitches are all a part of BFS. So if you have ben diagnosed with BFS, you have to be prepared for them. End to the story.
The video is btw not showing a "true" fasciculation per definition, but it is the kind of tongue muscle twitch/spasm that most of us get. Matt had tons of those, together will all kinds of other fasciculations. Me not...I mostly had the little flickering true fasciculations like in the youtube video....like many many others here. They just stopped at one point.
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Re: Calling on TwitchyDoc -- Tongue Fascics

Postby TwitchyDoc on September 10th, 2013, 8:19 am

Just an comment to what Matt correctly pointed out: having fasciculations like on that video does not mean you have MND. It was to show a difference between fasciculations and other abnormal movements. It is possible you do not have tongue fasciculations at all, or you do. I definitely do.
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Re: Calling on TwitchyDoc -- Tongue Fascics

Postby js1 on September 10th, 2013, 10:01 am

Wow. Thanks for all the replies -- not sure if my fasics are like that video (which I unfortunately have seen). Sometimes I'll get little dimples while at rest, but I feel as though its the fibers that aren't completely resting because I can't feel the twitch. The twitches in this video comes on by exertion and the edges will pull like crazy after resting --- it's good to know it's not a normal fasiculation, but I've heard that fasics produced by exertion are less insidious? Thanks again.
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Re: Calling on TwitchyDoc -- Tongue Fascics

Postby js1 on September 10th, 2013, 10:14 am

Should clarify -- not dimples, almost like indentions that follow the muscle fiber.
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Re: Calling on TwitchyDoc -- Tongue Fascics

Postby chrissi on September 10th, 2013, 10:47 am

The indentions you are describing look like the fasciculations I had. The could be like a little rice corn or bigger ( longer), pulsating by creating an indention. Mine went on- off- on- off for hours at the same spot. A good video of those was shown by twitcherHH
http://www.aboutbfs.com/forums/viewtopic.php?f=8&t=17925&p=133455#p133455
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Re: Calling on TwitchyDoc -- Tongue Fascics

Postby js1 on September 10th, 2013, 11:22 am

Chrissi, thanks. The little flicks I get usually show up after opening my mouth and trying to position the tongue; they don't look like the pulses in TwitchHH's video. This is why I think they might be resting tongue movements. The only "twitch" I seem to have on a consistent basis is the one like in the video -- a continuous contraction/pulling of the muscle fibers toward the front of the tongue after exerting it. The reason I worry is because I've read that MND fasics look like a bag of worms and the pulling is what I'd associate more with worms than the little flicks as TwitchDoc describes. My full story is in the Support Group.

I had a clean EMG after around 1 1/2 months done by a top MND specialist at Cedars, but I continue to see my symptoms worsen. Feels like I am having intermittent trouble swallow thick saliva and my voice will get hoarse throughout the day. No slurring as far as I can see, but I'm just frustrated. I went through this scare 9 years ago, but my symptoms have returned and they are significantly amplified. And I still have a complex twitch in my abdomen that goes 24/7 -- most of the time can't see it without light. I'm at a loss.
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Re: Calling on TwitchyDoc -- Tongue Fascics

Postby bobajojo on September 10th, 2013, 12:00 pm

James,
My neurologist once told me that whenever a patient says "it feels like", its not concerning. With ALS, there is no "feels like", its "I can't". Saying it "feels like" is very common with BFS. These strange symptoms have us all on edge. In your fist post, I recall you saying you have anxiety which is very common on here as well. Many of us have had the same throat issues you describe.

Regarding your pulling twitch, please read what I posted above and see my video. I showed this to my neuro and he said it is not a worrisome twitch at all. Mine does it all the time and has done it for 2 years. I'm not worried and neither should you. Forget about what you read on other forums.

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Re: Calling on TwitchyDoc -- Tongue Fascics

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