Tongue Atrophy

I have noticed a scalloped appearence (tooth marks?) to the top sides of my tongue and was wondering if this would be a sign of atrophy.  I don't seem to have any strength problems, nor do I seem to have any movement problems with my tongue.  Is it possible for atrophy to occur before any other noticible problems?  My tongue does quiver quite a bit when I stick it out, but I don't notice any fascics when it is at rest in my mouth.  (I thought it was normal for a tongue to quiver when extended)
For background, I saw a neurologist in December about muscle twitching located in various areas of my body.  At the time he mentioned BFS, but said to come back in 6 months.  Since then things have progressed and have also been made worse by extreme anxiety. (I'm currently on 100 mg of Imipramine for anxiety)  I think to a certain extent I have been aggravating/manufacturing symptoms.  For example, a few days after reading about bulbar onset ALS I started noticing that a few crumbs of food would remain in the back of my throat after swallowing.  Not everytime, and frankly it occurs most when I think about it.  Early on, I was so worried about it there were times I felt like I was gagging.  
I have another Neurologist appointment on the 28th of January, which seems like an eternity.  I'm going to ask for an EMG at that time for peace of mind. (God willing)
Sorry so long.  Thank you very much for your opinion on this matter.

[CCF-Neuro-M.D.-JT]

Atrophy of the tongue refers to wasting away of the tongue muscle so that it eventually shrivels up and then cannot move. ALso, many patients have a little "quivering" when it's protruded from the mouth. The important point is to look at it (by a neurologist) while it's at rest as you mentioned in your post.

I can certainly understand how frightened people can be with the increasing public awareness about ALS. The most important thing to do is keep your appointment with neuro and see what they think as they have the opportunity to examine you. Anxiety also can play a big role in the twitching. Eat slowly if you are concerned about choking. GOod luck.

[twitch_city]

Sorry to post before the doctor.  Does twitcher need to get an EMG of the tongue in order to have a diagnosis of Bulbar onset.  I have been told this but I am still unsure.  If only the bulbar area is affected would an EMG of the lower extremes pick it up?

[twitch_city]

EMGs AND DIAGNOSIS
From "Ask the Experts," on the MDA Forum on CompuServe. "GO MDA."

Q. I would like to know if EMGs (electromyograms) done on the limbs of the body can detect a bulbar onset of ALS (early appearance of symptoms in the throat and mouth muscles). If not, what test can and should be done to check for a bulbar onset? Also, how important is a muscle biopsy in the detection of ALS if EMGs appear normal?

A. From Dr. Robert McMichael, MDA clinic director, Ft. Worth, Texas: If the limb EMG is characteristically abnormal, it helps establish the diagnosis of bulbar-onset ALS. A tongue EMG, if abnormal, strongly supports the diagnosis, if alternate diagnoses such as brainstem lesions are excluded.

A. From Dr. Mark B. Bromberg, MDA clinic director, University of Utah, Salt Lake City: In making the diagnosis of ALS, the site of onset is less important than the distribution of lower and upper motor neuron damage. The EMG is a sensitive technique for detecting lower motor neuron damage in body regions that are not yet weak. Thus, abnormalities in the EMG can be used to help make the diagnosis of ALS early on when there is only weakness of bulbar muscles.

One advantage of the EMG is that it can be applied to a number of different muscles and is far less invasive than a muscle biopsy. If an alternative diagnosis is in question, sometimes a muscle biopsy can provide specific information.

[B-Man]

I am the same as you (when looking at another part of this horrific disease, I start thinking I possibly have those symptoms).  I recently had an EMG done on my arms and legs due to twitching in my feet and calves, and all came back good (except for some Diabetic Neuropathy in my feet [I am a Diabetic]).  I was good for approximately a week after that, then I started wondering if this thing could be the Bulbar type and he couldn't see it on the EMG that was done on my limbs.  I then started looking at my tongue in the mirror and noticed a dent on the top one side of it.  Then I thought I was slurring my words.  I think the mind is a terrible thing at times.  I spoke to my shrink and she said "don't you notice......once you get a portion of this satisfied (ruled out), then you move on to the next thing.....She is absolutely right and I am trying so damn hard to take her advice and try to forget about these things.  It becomes hard to just "forget it" when you have been thinking about this for 5 months STRAIGHT.

My advise (take it for what it is worth).......try not to let this overcome you......I have teeth marks in my tongue, but I do notice that I press my tongue quite hard against my teeth when I am at rest (probably due to stress).  

I wish you luck and I am sure you are fine.
BR
Brian

[Twitcher]

You're 100% right.  I've struggled with anxiety problems for years now.  I had an appointment with a Neurologist today and he said I am perfectly normal neurologically.  He saw no fascics in my tongue and said it showed no signs of atrophy.  He did suggest that I have an EMG and NCV done just to finally put my mind at ease.  It's funny that you mentioned going from one type of the disease to another.  That's the exact same thing I did.  A few weeks ago I thought my hands were showing signs of atrophy.  Hard to believe this all started with minor tremors in my hands.  I let my imagination and fear get the best of me.  Good luck to you and everyone else here.

[Craig]

The paraspinals are specific for bulbar onset ALS. If they did any sticks in your back or neck you're pretty much home free. Bulbar onset accounts for 25% of all cases and is more common in older females so the odds are really low.

[squirrely]

I have problems with my tongue. I would have a sore tongue in the morning or it would get ulcers on it or it felt burned. I went to many, many doctors. Found out that the ulcers are caused from sinus infections because I have asthma, allergies, and I smoke and this I found out on my own by keeping track of my health since the doctors had no answers. All the doctors I went to said the ulcers were possibly caused from my ulcerative colitis, I knew they were wrong because everytime I'd get them I had a sinus infection but the doctors would have none of that reasoning. The ulcers would also spread to other areas of my mouth, once the sinus infection cleared up so did the ulcers. as for the soreness of my tongue on both sides of it. I had testing done that showed I have petite mal epilepsy and I was taking seizures in my sleep at times. The burning feeling of my tongue is what is called the "burning tongue syndrome", and there is no cure for it except prednisone and that is also used to clear up the ulcers that come at times on my tongue and in mouth. I hope this helps someone as I have talked to other people at some of the medical centers I went to and a few have been having the same problem regarding the sore tongue and/or ulcers.

[Worrygirl]

I completely understand what you are all going through. I have had a sore tongue before, but thought nothing of it until I started worrying about ALS.I too feel like my tongue and throat muscles are not working properly. I am a 25 year old female and my only symptoms are a slight weakness in my left hand, a sore tongue sometimes and some muscle and joint pain sporadically. I too have problems with anxiety so I really pray that all this stems from that. I don't have the courage to get the EMG done, because I am terrified of finding out I have this horrible disease. I feel like I can write off some of the other symptoms, but it is the tongue soreness that is really worrying me because I was so totally perplexed as to why my tongue, of all things would be sore.That just really scares me and it is keeping me from being happy. I guess I should go to the neuro to just get it out of the way, but like I said I am very scared.:(

[Twitcher]

The best thing you can do is go see a doc.  I worried myself sick (literally), but after seeing a Neurologist that I trusted I feel much better.  More than likely, they are going to tell you you're fine.  Anxiety can cause a ton of problems that SEEM like some awful disease.  ALS is scary, but it is rare and most people that develop it are over 40.  See a doc and then get on with your life.

[Jl425]

A related discussion, How long till you know what's going on? was started.