Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of an elderly woman with dementia showing episodic involuntary movement of the tongue

Takahiro Mitsueda, M.D., Ph.D.1), Yoshifumi Nakaya, M.D., Ph.D.1)2), Mai Hagiwara, M.D.1), Tatsuo Manabe, M.D.1) and Masaru Matsui, M.D., Ph.D.1)

1)Department of Neurology, Otsu Red Cross Hospital
2)Department of Neurology, Kyoto University School of Medicine

We report a 93-year-old woman with dementia who developed generalized convulsion and involuntary movement of her tongue. She could independently walk and eat meals until 8 months ago, however she turned into bedridden. When she was admitted to our emergency room due to status epilepticus, her tongue intermittently moved from the midline to the left. She could not eat or speak during this episodic tongue movement. MR imaging study revealed brain atrophy in the bilateral mesial temporal lobe, consistent with senile dementia of Alzheimer type. Despite her tongue movements seemingly developing to the generalized convulsion, EEG study did not indicate epileptiform discharges corresponding to this movement. Although antiepileptic drug therapy was effective, we needed polytherapy to control this movement. Paroxysmal tongue movements were previously reported in cases of epilepsy, brain tumor, and stroke, observed bilaterally in most cases. This episodic tongue movement would be rare in terms of the clear laterality. The etiology of this movement was presumed as focal seizure, palatal tremor, dyskinesia or others, but was undetermined. Episodic movements involving tongue decrease the quality of daily life especially in the elderly. Therefore, we should pay more attention to it and try to treat it earlier.
Movie legend
Episodic involuntary tongue movement. The right side of her tongue seemed to protrude and eventually deviated from midline to the left, while the patient was awake accompanied by the tremulous movement of her jaw. A series of involuntary movements lasted for several seconds and repeated.
Supplemental video
Full Text of this Article in Japanese PDF (2174K)

(CLINICA NEUROL, 54: 321－324, 2014)
key words: episodic tongue movement, senile dementia of Alzheimer type, elderly patient

(Received: 26-Dec-12)