Focal epilepsy presenting as tongue tremor: A case report

Abstract

Plenty of etiologies are reported to cause tongue tremor. Focal epilepsy presenting as isolated tongue tremor is a rare condition, suggesting how variable the focal seizure presentation may be. This paper reports a case of focal epilepsy due to presence of a cavernous angioma in the region of cortical motor area related to tongue movements. It is an clinical example of pathological conditions affecting the tongue area in motor homunculus.

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

“…7 This association of eye deviation helps differentiate LS from lingual tremors, which are more common and seen in Parkinson's disease, brainstem lesions, Wilson's disease, and drugs. 4 8 9 This child did not have any precipitating factor for LS, like arm movement or rubbing of the scalp, as was previously reported in a patient with LS. 1 Nonepileptic abnormal movements of the tongue are more common as compared to LS.…”

“…1 2 3 Lesions of the motor area and insula could result in LS. 4 5 Benign childhood epilepsy also needs to be considered in the differential diagnosis of LS, as orobuccal and lingual involvement is an important component of benign childhood epilepsy with centrotemporal spikes without focal brain lesions. 6 Our child did not have features of benign childhood epilepsy.…”

“…1 Nonepileptic abnormal movements of the tongue are more common as compared to LS. 4 A rhythmic movement of the tongue that does not affect tongue movements or speech and without focal eye deviations helps diagnose lingual tremors. 8 9 In addition, lingual tremors are associated with hand tremors or features of underlying diseases, like Wilson's disease or Parkinson's disease.…”

Clinical Neurology in Practice

“…95 Tongue may sometimes be involved during a seizure, usually as part of a Jacksonian seizure, rarely in isolation. 96,97 But, conversely to the harmful myth that persists in modern culture (though medical and nonmedical literature, TV, and film), "one cannot swallow their tongue during a seizure". 98 After labial stimulation or nonnutritive sucking during sleep, rhythmic lingual movements can be observed in asymptomatic newborns.…”

“…Often of unknown etiology, it rarely occurs in isolation (either episodic or continuous), usually being present as part of myoclonus of the palatopharyngeal muscles or other movement disorders involving oculofacial, diaphragmatic or shoulder muscles: it may be due to brainstem lesion or cortical injury (such as stroke) 95 . Tongue may sometimes be involved during a seizure, usually as part of a Jacksonian seizure, rarely in isolation 96,97 . But, conversely to the harmful myth that persists in modern culture (though medical and nonmedical literature, TV, and film), “one cannot swallow their tongue during a seizure” 98 .…”