Lingual fasciculation: A point of call for the diagnosis of amyotrophic lateral sclerosis

Abstract

A 60-year-old female patient, with no notable medical history, was referred by the internal medicine department for a dry mouth workup. The clinical examination revealed an absence of dryness, and the presence of lingual fasciculations, associated with difficulties in mastication and phonation. These symptoms appeared spontaneously 9 months before the consultation, after leaving confinement. Given the presence of lingual fasciculations, the diagnostic hypothesis of a neurological pathology, in particular amyotrophic lateral sclerosis (ALS), was suspected. After performing an electromyogram (EMG), the diagnosis of ALS was retained. Riluzole treatment was then started, and physical therapy sessions were scheduled. Riluzole allows an average gain of 4 to 6 months of life expectancy. Speech therapy and physical therapy allow to maintain the functions as long as possible and to improve the end-of-life conditions. The interest of early detection of ALS allows delaying the progression of the disease.

Dental Management of Patients With Amyotrophic Lateral Sclerosis

“…Muscle weakness can result in dysphagia that leads to food debris staying in the mouth, which subsequently leads to the promotion of periodontal diseases [17][18][19]. Additionally, many reports described cases with macroglossia, atrophic tongue, fasciculation in the tongue, masticatory muscle pain, and progressive limitation of mouth opening [14,17,20]. Macroglossia tends to increase in prevalence with the progression of the disease, and it has a negative impact on communication [21][22][23].…”