Diagnostic Approach and Management of Abnormal Tongue Movements

Initial Diagnostic Approach

The American Academy of Neurology recommends examining for positive signs that distinguish between etiologies, such as functional movement disorder features, which include inconsistent movements that vary with attention, distraction, or during spontaneous conversation, presence of excessive effort, struggle behaviors, or unusual tongue postures, and symptoms that are internally inconsistent or disproportionate to any structural findings 1, 2, 3
A thorough history should assess for functional disorder indicators, including sudden onset or onset following a specific stressor, symptom variability with attention, distraction, or during automatic activities, presence of other functional neurological symptoms, and psychological stressors, trauma history, or comorbid anxiety/depression 1, 2, 3

If functional movement disorder is diagnosed, the American Academy of Neurology suggests implementing speech and language therapy with motor retraining as primary treatment, including education and explanation, symptomatic treatment strategies such as natural reflexive behaviors, attention redirection, and physical maneuvers, and psychological intervention to address predisposing, precipitating, and perpetuating factors 1, 2, 3, 4, 5, 6, 7
The American Academy of Neurology recommends that treatment structure should include intensive therapy, with multiple sessions per week, showing superior outcomes, and addressing psychiatric comorbidities, such as anxiety and depression, which are common perpetuating factors 1, 2, 3

The American Academy of Neurology advises against dismissing functional disorders as "psychogenic" or "not real", as these are genuine neurological conditions with specific positive diagnostic features requiring active treatment 2, 3
The American Academy of Neurology recommends not assuming psychiatric comorbidity precludes functional disorder diagnosis, as anxiety and depression are common perpetuating factors, not exclusion criteria 2