Conditions
Tongue Dystonia

Involuntary dystonic movements of the tongue are uncommon. The tongue starts to poke out when patient attempt to speak or eat. The tip of the tongue sometimes goes up or is animated with writhing movement inside the mouth, like if the patient is having a sweet inside his mouth. It can be very disabling socially as the people stare at the patient like if he is making faces. It can interfere with eating as the tongue can push out the food or does not move the food backward in order to swallow. It can also interfere with speaking, the patient become difficult to understand.



It can be isolated as a focal dystonia, or be associated with opening jaw spasms, or progress to spasm affecting the all face (Meige syndrome). Most often tongue dystonia are primary, but sometimes it can be related to neuroleptic treatment and very rarely it can be due to a rare neurological condition.

Treatment

Injection of the tongue with BTX can be done by neurologists specialized in this condition. Injections can be done with or without electromyographic guidance depending of the muscles involved in the spasm. If swallowing difficulties are already present, videofluoroscopy can be helpful to appreciate the role of the tongue dystonia in the swallowing.

The most common injected muscle which is responsible of the protraction of the tongue is the Geniogloss.

The possible side effects of the injections are the swallowing difficulties. Sometimes nasogastric tube feeding can be required for 2 weeks if the patient is choking on food or fluids after the injections