A neurologist explains if it’s normal for a tongue to twitch when you hold it out to examine it due to bulbar ALS fear.

People with a fear of bulbar onset ALS will stick their tongue out and hold it in one spot to see if it twitches.

It’s difficult to hold the tongue perfectly still, so invariably, it moves, and you may incorrectly interpret these movements as fasciculations with a pathological cause.

“It is not necessarily pathological for one to experience twitching in the tongue when protruding it,” says Bonnie Gerecke, MD, director of the Neurology Center at Mercy in Baltimore.

“Twitching can be due to a variety of conditions such as anxiety, hyperthyroidism, hypoglycemia (low blood sugar) and even in normal individuals,” explains Dr. Gerecke.

Fasciculations, which are different than just twitching of the tongue, is often more pathological, but is rare and is often not seen in isolation in patients with ALS.

“That is to say that if there are fasciculations in the tongue of a patient with ALS, he or she also will likely have dysarthria (slurred speech) and perhaps trouble chewing or swallowing.”

Stop sticking out your tongue to inspect it for twitching.

Give this a rest. Enjoy your food and talking. If there’s difficulty swallowing, chewing or speaking as a result of bulbar ALS, even early ALS, you will know this without having to consciously try to detect it.

Think about that for a moment: Difficulty swallowing, chewing or speaking without slurring are symptoms that are impossible to miss!

You do not need to constantly be inspecting your tongue, subjecting this muscle to the tiring act of holding one position.

For additional reassurance, ask all of your friends to stick out their tongue and try to hold it still without it “twitching.”


If you’re reluctant to make this request of adults, ask children; disguise the request as a game.

Have a stopwatch and ask the child to see if they could stick out their tongue and hold it there for 20 seconds without it moving.

You will see the same “twitching” in this experiment as you do with your own tongue.

Dr. Gerecke has a special interest in ALS, myasthenia gravis, myopathy/muscular dystrophy, peripheral neuropathy and radiculopathy. She is board certified in general neurology and neuromuscular medicine.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  



Top image: Shutterstock/ShotPrime Studio

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