seizures and tongue lacs

30 Dec


–my patient had some sort of ‘episode’, story is unclear
–does their tongue lac tell me anything? was this a seizure?

PUBMED BIOPSY (not a ton out there):
STUDY 1: “Value of tongue biting in the diagnosis of seizures”
–study of 106 patients admitted to epilepsy unit + 45 patients with syncope
–small sample size, but interesting

–8/106 seizure patients had a tongue lac: all on the side
–1/45 syncope patients had a tongue lac: at the tip.

–sensitivity of 24% and a specificity of 99% for the diagnosis of generalized tonic-clonic seizures.
Lateral tongue biting was 100% specific to grand mal seizures.

STUDY 2: The diagnostic value of oral lacerations and incontinence during convulsive “seizures“.

–84 patients on EEG
–trying to tell seizure from pseudoseizure (a.k.a. psychogenic non-epileptic seizure, or PNES)

oral lacs: (p=0.01)

  • seizure: 26% (17/66) —14 side of tongue, 1 tip of tongue, 2 cheek, 3 lip
  • not a seizure: 0% (0/18)
  • sensitivity 26%, specificity 100%

Incontinence: (p = 0.09)

  • seizure: 23% (15/66)
  • not a seizure: 6% (1/18) –!!! (now that’s commitment)
  • sensitivity 23%, specificity 94%

side-of-tongue lac is near 100% specific for seizure, not very sensitive
–if the story fits, and you bit the side of your tongue and/or pissed yourself, you probably earned a seizure workup

Reference(s): tongue biting, oral lacs and incontinence, picture


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