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Cascais I, Ashworth J, Ribeiro L, Freitas J, Rios M. A rare case of tongue biting during sleep in childhood. J Clin Sleep Med 2024; 20:653-656. [PMID: 38152859 PMCID: PMC10985298 DOI: 10.5664/jcsm.10966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
Bleeding tongue-biting episodes during sleep are a rare and alarming situation that can negatively impact the child's and parents' sleep, affecting their quality of life. Although highly suggestive of epilepsy, a differential diagnosis should be made with sleep-related movement disorders such as bruxism, hypnic myoclonus, facio-mandibular myoclonus, and geniospasm when this hypothesis is excluded. The clinical history, electroencephalogram, and video-polysomnography are essential for diagnostic assessment. Treatment with clonazepam can be necessary in the presence of frequent tongue biting that causes severe injuries and sleep disturbance. This study reports the challenging case of managing and diagnosing a 2-year-old boy with recurrent tongue biting during sleep since he was 12 months old, causing bleeding lacerations, frequent awakenings, and significant sleep impairment with daytime consequences for him and his family. CITATION Cascais I, Ashworth J, Ribeiro L, Freitas J, Rios M. A rare case of tongue biting during sleep in childhood. J Clin Sleep Med. 2024;20(4):653-656.
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Affiliation(s)
- Inês Cascais
- Department of Pediatrics, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António (CMIN-CHUdSA), Porto, Portugal
| | - Joanna Ashworth
- Department of Pediatrics, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António (CMIN-CHUdSA), Porto, Portugal
| | - Lúcia Ribeiro
- Department of Neurophysiology, CMIN-CHUdSA, Porto, Portugal
| | - Joel Freitas
- Department of Neurophysiology, CMIN-CHUdSA, Porto, Portugal
| | - Marta Rios
- Department of Pediatrics, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António (CMIN-CHUdSA), Porto, Portugal
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Hu G, Pan Y, Yuan N, Yang Z, Shi X, Ma S, Li S, Hou X, Liu F, Li D, Bao J, Liu Y. Tongue Biting Event in Patients with Sleep-Related Facial Mandibular Myoclonus: A Case Series Study. Nat Sci Sleep 2024; 16:207-215. [PMID: 38410526 PMCID: PMC10895986 DOI: 10.2147/nss.s433628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/28/2023] [Indexed: 02/28/2024] Open
Abstract
Background Sleep-related facial mandibular myoclonus (SRFMM) remains rare in clinical practice. The aim of this study was to provide a comprehensive understanding of the electroclinical manner, therapeutic regimen, and prognosis of SRFMM. Methods Twenty-three patients who were diagnosed with SRFMM by clinical manifestation, video-electroencephalography (EEG) and electromyography over bilateral masseter and temporalis muscles were enrolled. Clinical and electrophysiological evaluation as well as follow-up information were recorded and analyzed. Results The cohort involved 4 infants and 19 adults with a mean onset age of 43.5 years for SRFMM, among whom 19 were male. Twenty-one patients complained of tongue injuries and disturbed night-time sleep. SRFMM in 4 patients were ascribed to oral aripiprazole, brainstem ischemia and brain trauma. In 62 SRFMM episodes, 93.5% occurred in NREM sleep and 6.5% in REM sleep, and all events were associated with EEG arousals. In 13 patients with or without clonazepam, the motor events gradually disappeared, and the rest turned to be sporadic. Conclusion SRFMM is a characteristic parasomnia manifested by tongue biting and accompanying facial mandibular myoclonus, leading to disrupted sleep. Besides adults, infants can also experience SRFMM with spontaneous remission. Most patients respond well to clonazepam, eventually with favorable prognosis.
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Affiliation(s)
- Gengyao Hu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China
| | - Yuanhang Pan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China
| | - Na Yuan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Xiuyu Shi
- Department of Pediatrics, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China
| | - Sha Ma
- Department of Neurology, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, People’s Republic of China
| | - Shan Li
- Department of Neurology, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, People’s Republic of China
| | - Xiaohua Hou
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Fei Liu
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Dongmei Li
- Department of Dentistry for Special Services, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China
| | - Junxiang Bao
- Department of Aerospace Hygiene, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China
| | - Yonghong Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, People’s Republic of China
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Zhang S, Aung T, Lv Z, Zhao X, Wang P, Shi T, Guo S, Geng Y, Jin B. Epilepsy imitator: tongue biting caused by sleep-related facio-mandibular myoclonus. Seizure 2020; 81:186-191. [DOI: 10.1016/j.seizure.2020.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/22/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022] Open
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