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Images in Neurology |

Isolated Lingual Dyskinesia in Multiple Sclerosis

Jung E. Park, MD1; Katharine Alter, MD2,3; Mark Hallett, MD1
[+] Author Affiliations
1Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
2Functional and Applied Biomechanics Section, Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
3Eunice Schriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
JAMA Neurol. 2015;72(10):1196-1197. doi:10.1001/jamaneurol.2015.1456.
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This case report describes involuntary lingual dyskinesia with nearly continuous rhythmic movements of the genioglossus in a patient with multiple sclerosis.

A woman in her 50s with multiple sclerosis (MS) presented with a 5-year history of daily involuntary tongue movements that began abruptly approximately 1 year from the onset of MS symptoms. She reported that the involuntary tongue movements mostly occurred with the mouth closed and disappeared while she was eating or speaking. The movements distracted the patient greatly at night prior to falling asleep. A sensory trick of placing a straw between the teeth diminished the movements. The patient reported pain and a sensation of dripping pus on the right side of the face, but there was no temporal association with the tongue movements. There was no history of exposure to neuroleptic agents.

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Magnetic Resonance Images of the Brain and Electromyographic Findings of the Tongue

A, Sagittal view of magnetic resonance imaging (fluid-attenuated inversion recovery sequence) with hyperintensities in the brainstem suggestive of demyelinating plaque. Inset, Axial proton density–weighted magnetic resonance images of the medulla with hyperintensities in the hypoglossal nuclei (arrowhead, top image) and pyramids (arrowhead, bottom image). B, Dystonic bursts of electromyographic activity. C, Large-amplitude and complex motor unit action potentials of prolonged duration.

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Lingual Dyskinesia

Nearly continuous writhing movements of the genioglossus observed on ultrasonography.

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