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.

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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!

      • Russell Bean says:

        Since this post you put up in 2017 how are you now in Oct 10th 2019 ? Have the doctors said it is ALS I HOPE NOT.i would hate you having to go through this if it is ALS especially if its bulbar strain like I have.well take care be thinking about your situation in the next few months.

    • 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.

    • Russell Bean says:

      I’m no doctor but I have a major speach problem my doctors at emory midtown seem have centered on bulbar ALS mine started 4 months ago I am getting some twitching in my lefT shoulder and arm. I wish what you tell was just simple issues but sure looks like a form of ALS. emory here in Atlanta ga are very good with ALS they have teams that deal with it you must fight with all you can I have started working out some to help my arms and working hard on my voice. Well take care and pray a lot over it I do for sure.

  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

    • Russell Bean says:

      Try and contact a doctor Andrew t tkachuk MD he is assistant professor of dept of otolaryngology head and neck surgery emory university hospital midtown his team are the very best at this his no. 40477830308. If you can see him you will really like him he is really on top of this issue.

  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.

    • suzanne wagner says:

      My Father-in-law died from ALS. He served in the military and now the military gives my mother-in-law a
      monthly check.

      My sister-in-law is now having medical problems and they believe she has ALS. I’m not sure that she has ALS. I think the doctors are jumping to a conclusion
      because of her fathers ALS. We can’t find any traces of family prior to my Father-in-laws family having the disease. Where can I see the information you have soI can present it to my in-laws?

  5. Zack says:

    I recently have experienced fatigue in my legs with muscle twitching, especially at evening rest time. Also in my arms as well as weakness. Tremendous weight loss and constipation, with no blockages in stomach. I’ve also had gagging for no reason and struggle with breathing at rest. Is this the beginning signs of ALS?

  6. Luka says:

    My first ALS symptom appeared in 2011. 4 years ago I learnt about ALS/MND successful chinese medicine from Rich Herbs Foundation (ww w. richherbsfoundation.c om), the treatment made a tremendous difference for me. Few weeks into the treatment I had improved muscle strength and coordination, improved speech, improved walking balance, increased appetite, improved eyesight and improved mood swings. 4 years since the treatment, i still feel stronger than ever with no symptoms at all, only occasional tingling on my right foot at night. I feel cured from the disease!

    • Clara says:

      Luka, If you have gone 4 years with no decline, you did not have ALS. You claimed you had “symptoms” . Please do not promote some Chinese herb as a cure to this devastating disease.

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  8. Alex kay says:

    My sister has been concerned about a weird “pulling sensation” in her throat. It has been going on for a couple months – she found an ENT dr that she likes & has a CT scan performed. CT scan didn’t show anything abnormal. She also has muscle twitching throughout her body. The past 2 months for her have been extremely overwhelming and full of much stress/anxiety. Does this fall in line for ALS?

  9. Carrie says:

    I’m a 48 yr old female. Started having problems with eating as my tongue would get tired. Had to start eating soft food. Noticed my arms and legs would get weak in the shower after washing my hair. Driving takes much effort and so does walking, just feels like I walked 100 miles. Rigid muscles. My muscle tone is gone. This all sort of crept up on me in the past 9-12 months. Getting an EMG on June 12, trying to stay hopeful.

  10. Michelle says:

    My first symptoms of Amyotrophic Lateral Sclerosis occurred in 2009, but was diagnosed in 2011. I had severe symptoms ranging from muscle weakness, shortness of breath, balance problems, couldn’t walk without a power chair or a walker, i had difficulty swallowing and fatigue. I was given medications which helped but only for a short time. So i decided to try alternative measures and began on ALS Formula treatment from Herbal Health Point, It has made a tremendous difference for me (Visit ww w. herbalhealthpoint.c om).  I had improved walking, balance, increased appetite, muscle strength, improved vision

  11. Michael says:

    Why to see a neurologist’asap’? If it is ALS, sadly no neurologist can help with it anyway. I have have symptoms very similar to you, but I feel I fare much better steering clear of the medical profession.

    I wish you both the best!!

  12. Taylor Howard says:

    Am Taylor Howard by name, i was diagnosed with ALS for 8 years and i lived in pain with the knowledge that i wasn’t going to ever be well again i contacted so many herbal doctors on this issue and wasted a large sum of money but my condition never got better i was determined to get my life back so one day i saw a post about Herbal Health remedies Foundation , i contacted Herbal Health remedies Foundation , we spoke on the issue i told them all that i went through and they told me not to worry that everything will be fine again once i used their herbal product, so they send it to me through courier service and told me how to use it, after 15 days of usage I went to see the doctor for test then the result was negative am the happiest woman on earth now. Thanks to Herbal Health remedies Foundation.

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