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My tongue twitches a few times everyday. It's been going on for three months. First it was maybe once a month, but the last week it's been a few times a day.

1. Can one have benign tongue fasciculations, or is it always indicative of ALS?
2. I'm 25, how rare is bulbar onset ALS in my age group?
3. I had an emg of tongue done one month after the first twitch. That was clean. I later heard from a neurologist that emg's can be performed to early, and that I should have waited 6 months after the first twitch to have the emg. Is this true?
4. Can ALS start with this type of infrequent fasciculations that slowly becomes more freguent?

Category: Neurologist, Medical

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Category: Pediatric Neurologist
 19 Doctors Online


Thank you for posting your query at

I have noted your symptoms.

ALS is unlikely to start with fasciculations in tongue alone. Bulbar onset ALS is uncommon at a young age such as yours.

Benign fasciculations may involve tongue. If ALS begins with tongue fasciculations, it is usually accompanied with other symptoms such as slurred speech and difficulty in swallowing.

EMG was done at the right time, however, it should be repeated after six months to completely exclude ALS.

I hope it helps.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)
Senior Consultant Neurologist

Patient replied :

I was wondering if you could answer to the frequence of fasciculations in als. Are they more frequent or could they be this infrequent in the beginning?

Thank you for getting back.

In ALS, fasciculations are more frequent and not infrequent.

Best wishes,

Dr Sudhir kumar MD DM (Neurology)

Patient replied :

Could als start with this type of infrequent fasciculations that slowly becomes more frequent?

It is unlikely that ALS would start with infrequent fasciculations located in one part of body, in this case, tongue. Even if patient notes fasciculations in one part of body, a neurologist would be able to elicit fasciculations elsewhere too, by manoeuvres such as hyperventilation.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

Patient replied :

My neuro said that once fasciculations start in one muscle they are constant or nearly constant in that muscle. Is this typical? Can I stop my worries about als?

Yes, in ALS, fasciculations should be frequent and constant.
So, kindly stop worrying about ALS.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Dr. Sudhir Kumar
Category: Pediatric Neurologist
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
Dr. Sudhir Kumar and 4 other Medical Specialists are ready to help you

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