Abnormal Undulating Tongue Movements Attributed to Delayed Post Radiation Myokymia
Alexis Coalson1, James Grogan1, Patrick Bergquist1, Jordan Yaukey1
1Pennsylvania State University Hershey Medical Center
Objective:
To showcase video demonstration of two cases of delayed, radiation-induced hypoglossal neuropathy presenting with lingual myokymia.
Background:

Myokymia is a type of muscle contractions typically appearing as involuntarily muscle undulation or twisting. Though there are many causes, the most common subtype is ocular myokymia, which can be induced by stress, fatigue, or caffeine. Myokymia can also be seen associated with post-radiation plexopathies and rarely other nerve injuries. This presentation will explore two cases that highlight lingual myokymia along with video demonstrations.

Patient A is a 69-year-old male with a past medical history of squamous cell carcinoma of the left side of jaw and neck, now status post radiation therapy to those areas. He developed left arm pain, numbness, and weakness, with proximal muscles most affected approximately four to five years later. He also noted to have continuous, undulating tongue movements that started around the time of his left arm symptoms.

Patient B is a 63-year-old female with a past medical history of squamous cell carcinoma of the tongue base. She underwent lesion excision and numerous radiation treatments to the tongue. Approximately five years later, she developed atrophy, writhing movements, and weakness of the tongue, presenting to clinic initially for concern for bulbar-onset ALS. Two annual follow up visits showed no further motor decline or progression to other body regions.

Design/Methods:
A retrospective case analysis.
Results:
N/A
Conclusions:
Radiation therapy is well known to have a multitude of adverse effects, both immediate and delayed. Delayed post-radiation lingual myokymia is an example of a rarer event, presenting with involuntary, undulating tongue movements. Motor neuron diseases, such as bulbar-onset ALS, can present similarly, with abnormal tongue movements, dysarthria, and dysphagia. However, because the prognoses are very different, it is crucial to differentiate between these diagnoses to guide patient counseling and treatment.
10.1212/WNL.0000000000211623
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.