Objective: To compare the detection of tongue fasciculations between electromyography (EMG) and transoral motion-mode ultrasonography (TOMU) in patients with amyotrophic lateral sclerosis (ALS), and to explore the potential role of TOMU in the assessment of lower motor neuron involvement.

Background: Tongue fasciculations are a clinically important sign of lower motor neuron involvement in ALS and may appear early in the disease course. Fasciculations are spontaneous visible muscle movements and may be regarded as a hyperkinetic motor phenomenon in neuromuscular disorders. Needle EMG is the standard method for detecting fasciculations; however, its invasive nature and technical difficulty, particularly in patients with bulbar dysfunction, limit repeated use. Ultrasonography has emerged as a non-invasive technique for visualizing muscle activity, including fasciculations. TOMU enables direct visualization of the dorsal tongue musculature, but its ability to detect tongue fasciculations relative to EMG has not been well evaluated.

Method: This retrospective cross-sectional study included 10 patients with ALS who underwent both tongue EMG and TOMU. Fasciculation was defined as positive when observed at least once during each examination. Detection rates were compared using McNemar’s exact test for paired binary data. Agreement between EMG and TOMU was assessed using overall agreement and Cohen’s κ coefficient with a 95% confidence interval.

Results: Tongue fasciculations were detected in 4 patients (40%) by EMG and in 5 patients (50%) by TOMU. Detection rates were similar between the two modalities (p = 1.00). Overall agreement was 90%, and Cohen’s κ was 0.80 (95% confidence interval, 0.31–1.00), indicating substantial agreement. One patient showed tongue fasciculations detected only by TOMU, while no cases were positive by EMG alone.

Conclusion: TOMU demonstrated a detection frequency and substantial agreement comparable to EMG for tongue fasciculations in patients with ALS. Given its non-invasive nature and ability to visualize tongue muscle activity directly, TOMU may serve as a useful complementary tool for identifying lower motor neuron involvement, particularly in patients in whom EMG is difficult or poorly tolerated. Further prospective studies with larger cohorts are warranted to validate these findings.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/tongue-fasciculations-in-amyotrophic-lateral-sclerosis-compared-between-electromyography-and-transoral-ultrasonography/