Early Signs of Bulbar Disease in ALS May Be Evident in Tongue’s Movement While Talking

Early Signs of Bulbar Disease in ALS May Be Evident in Tongue’s Movement While Talking

Researchers report that evaluating a person’s control of tongue movement during speech can help to diagnose bulbar disease, especially in its early stages, in patients with amyotrophic lateral sclerosis (ALS).

ALS affects motor neurons in the brain, brainstem, and spinal cord. If patients show alterations in speech or swallowing abilities they are diagnosed with bulbar ALS. Indeed, as ALS disease progresses, 85 percent of patients exhibit bulbar disease.

The study, “Speech Movement Measures as Markers of Bulbar Disease in Amyotrophic Lateral Sclerosis,” published in the Journal of Speech, Language, and Hearing Research, aimed to determine if the mechanics of speech, as seen in tongue and jaw control, could be used as diagnostic markers for bulbar disease in ALS.

The standard clinical assessment of bulbar disease can be done by examination of the strength, range, speed of movement, and symmetry of oral musculature. However, these measurements can be subjective.

The authors proposed that mechanistic measurements of the tongue and jaw could allow the evaluation of independent structures involved in speech. This process could improve the assessment of a motor speech disorder resulting from ALS.

Researchers asked ALS patients to say the sentence Buy Bobby a puppy, while they recorded patients’ tongue and jaw movement. Information gathered allowed them to assess changes in movement size, speed, and duration according to disease severity.

Results showed that tongue movements’ maximum speed and duration were significantly different in patients with advanced stage bulbar ALS when compared with healthy controls.

At early stages of the disease, a reduction in the size and duration of tongue movements was seen, while as speaking ability further deteriorated, the speed of tongue movements further slowed and the speed of jaw movements increased.

These results indicated that tongue movement can be an appropriate marker of early changes in bulbar function. “A decrease in tongue movement size with disease progression may serve as a potential diagnostic marker for early detection of bulbar involvement,” the researchers wrote.

They also highlighted the importance of more studies to develop a protocol for detecting early signs of bulbar ALS, and for documenting disease progression over time and improving clinical trials.


  1. Hi my name is Brittany and I have been experiencing a few symptoms that I think are similar to als . It started with my hand tingling fingers weakness in my fingers I still have good strength in my hand and fingers . My legs and arms also feel fatigue as if I have been working out. I also have twitching and spasms all over my body . My tongue feels very weird and swollen with teeth marks on the side and twitching in the tongue and having to clear my throat a lot and my voice sound a little deep sometimes and all this has come about in the last weeks could I have als?

    • William schell says:

      Does not sound good:
      You need to see a good nuroligest asap.
      I take care of my son age 39 who has als sceince age 34;
      Good luck ; God bless ;

    • Tami says:

      You need to see an acupuncturist sounds like you have liver issues and blockage along with allergies. Chinese Doctors look at your tongue to determine health issues.

    • Anna bannana says:

      I cant speak
      I cant eat anything
      I use the coagh Assist 10-12 times daiy
      i have fallen 7 times
      I have a ZUVO to communcate
      I still walk a half mile

    • Sensory symptoms are uncommon in ALS, and nearly all are unaware of their fasiculations until pointed out by others, unlike what you describe. The differential is long, and can be as simple as an anxiety-like syndrome, but I would be very, very surprised if your symptoms represent a MND (motor neuron disease). You can start with any good doc who will refer you to a neurologist if needed. PSince it’s been a few months, please respond and give us an update. Best wishes!

    • ZsaZsa says:

      Have your thyroid functions(T3,T4,TSH uptake)checked. It’s a simple blood test. That feeling of a thick tongue and the deepening of your voice and the fatigue you’re experiencing are indications that you may be hypothyroidism. Get it checked out.

  2. Hi my name is Brittany and I’m 27 I have been having a few symptoms that I think are related to als . It started in my hands tingling fingers and my finger feel a little weak I still have a lot of strength in my hands . My legs and arms feel fatigued as if I just got done working out I have twitching and spasms all over my body literally everywhere. My tongue is swollen with teeth marks on the side and feels very funny with twitching as well and my voice is sometimes sounding deep and having to clear my throat I can move my tongue from side to side and up and down with no problem I also do not have trouble swallowing could I have als?

    • Anselmo145 says:

      Find a neurologist at a large university hospital. Ask him to screen you for Multifocal Motor Neuropathy (MMN).

    • Jesse says:

      Sounds like benign fasiculation syndrome. I have it. Along with some anxiety. Body wide twitches is hallmark of BFS, where als is localized, with clinical weakness and atrophy. Talk to a nurologist to ease your fears 🙂

  3. Deb Simonson says:

    I also woke up one morning in Jan.2017, with a thick tongue and sore cheeks that I had been biting. I resorted to using a mouth guard at night. It took over a year, MRI’s, C-scans, everything including speech therapy. Nothing helped and my speech was so slurred that my family couldn’t hardly understand me. I finally went to the Mayo Clinic in MN. And they diagnosed me with PLS within a hour. My speech is getting worse, drooling, problems with swollowing and starting to get the butterflies under my skin when I’m at rest. I try to work out everyday but the fatigue sets in quickly, and it’s a struggle to breathe

  4. Colorado18yr ALS Research has proven with a Denver ALS afflicted man that the physiology foundation of the body must be prepared for ANY form of stem cell therapy to allow complete recovery.If not these cells are just a band aid. ALS does not disease the body it “injures” adults. If ALS were actual disease it would go after children. This is the same with Alzheimers. This project shows how ALS is triggered, where it goes in a domino effect after triggering, and why medicine is light years behind this project. Veterans are twice as likely to be ALS diagnosed later in life regardless of war. This is not from genetics. Veterans affect physiology and not from physical trauma. Hitting the head does not trigger ALS. If it did you would see many boxers with ALS over the decades. You don’t see any. This project is ending ALS and is on twitter at 1854R. Please feel free to follow. There are now three people on this protocol. Medicine is ignoring it. Again light years ahead. That is all.

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