Multiple Sclerosis and the Tongue: A Surprising but Important Symptom

Introduction

When most people think of Multiple Sclerosis (MS), they imagine issues like muscle weakness, fatigue, or difficulty walking. But did you know that the tongue can also be affected by MS? 🧠➡️👅 It’s a lesser-known but very real issue that can have a big impact on quality of life — from speaking and eating to self-confidence and daily comfort.

In this article, we’ll explore how MS can affect the tongue, what symptoms to watch for, why they happen, and how to manage them effectively. Let’s dive in!

🧠 What is Multiple Sclerosis (MS)?

MS is a chronic autoimmune disease where the immune system mistakenly attacks the protective covering (myelin) of nerves in the central nervous system (CNS), including the brain and spinal cord. This disruption causes a wide range of neurological symptoms.

The cranial nerves, including those that control the tongue, can also be affected, leading to symptoms in areas people don’t expect — like the mouth, throat, and even taste.

👅 Why the Tongue?

The tongue is controlled by several cranial nerves, primarily:

The hypoglossal nerve (cranial nerve XII) – responsible for most tongue movements.
The facial nerve (cranial nerve VII) – involved in taste on the front two-thirds of the tongue.
The glossopharyngeal nerve (cranial nerve IX) – responsible for taste in the back one-third of the tongue.
The vagus nerve (cranial nerve X) – involved in swallowing and speaking.

Since MS can damage these nerves or the brain areas controlling them, it can lead to tongue-related symptoms such as weakness, numbness, tingling, and more.

🔍 MS-Related Tongue Symptoms

Here are the most common ways MS can affect the tongue:

🗣️ Dysarthria (Speech Difficulties)

One of the most noticeable effects of MS on the tongue is difficulty speaking.

Words may sound slurred.
The tongue may feel heavy or uncoordinated.
Speaking clearly can become exhausting.

Why it happens: MS lesions in the brainstem or damage to the cranial nerves can impair the muscles that move the tongue, lips, and jaw.

😛 Tongue Weakness

People with MS may notice that their tongue:

Feels tired after talking or eating.
Has reduced range of motion.
Doesn’t press as firmly against the roof of the mouth or cheeks.

This can lead to difficulty chewing, manipulating food, or even clearing food from the mouth.

💢 Tingling or Numbness

A pins-and-needles sensation in the tongue (paresthesia) is surprisingly common.

It may feel like your tongue is “asleep.”
Some people report burning or buzzing sensations.
Others may experience numb patches, often on one side.

These symptoms are typically related to sensory nerve dysfunction, especially in relapsing-remitting MS.

😖 Spasms or Stiffness

Rarely, MS can cause spasticity in the tongue muscles.

The tongue may stiffen or tremble.
You might notice jerky or involuntary movements.
Speaking or swallowing can become harder.

This type of symptom may be mistaken for other movement disorders.

🥴 Swallowing Problems (Dysphagia)

While dysphagia usually involves the throat and esophagus, tongue dysfunction can play a big part too.

If the tongue can’t move food effectively, it may lead to choking or coughing during meals.
People might feel like food gets "stuck."

Swallowing issues are serious and should be evaluated by a speech-language pathologist or neurologist.

👃 Loss of Taste

Some people with MS report changes in taste perception:

Food may taste bland or metallic.
Sweet, salty, or bitter flavors might be dulled.

This is usually due to nerve damage affecting taste pathways, particularly the facial and glossopharyngeal nerves.

📉 How Common Are Tongue Symptoms in MS?

Tongue-related symptoms aren't always the first signs of MS, but they are more common than most people think.

Speech issues (dysarthria) occur in about 40–50% of MS patients at some point.
Swallowing difficulties (dysphagia) affect up to 43%, especially in advanced stages.
Sensory symptoms like tingling or burning can appear in the tongue, lips, and facial area early on in the disease.

However, many of these symptoms are intermittent and may flare during relapses and improve during remission.

🧪 Diagnostic Clues: Is It MS or Something Else?

If you're experiencing strange tongue sensations, it’s important to rule out other causes:

Vitamin B12 deficiency – Can cause tongue tingling and burning. Want supplements for people with MS? Click here.
Diabetes – May lead to neuropathy affecting the mouth.
Stroke or mini-strokes – Can cause sudden speech or swallowing problems.
ALS (Amyotrophic Lateral Sclerosis) – Also affects tongue movement and speech.
Oral infections or dental issues – Can mimic some symptoms.

Your doctor may recommend tests such as:

MRI scans to detect MS lesions
Neurological exams to assess cranial nerve function
Swallow studies or speech evaluations

🛠️ Managing Tongue-Related MS Symptoms

Here’s the good news: There are strategies that can help! 😌💪

👩Work With a Speech-Language Pathologist (SLP)

SLPs can help with:

Speech clarity exercises
Tongue strength training
Swallowing techniques
Customized diet modifications to prevent choking

They often use oral motor exercises and tools like straws, spoons, and resistance devices to help retrain the muscles.

🧘Manage Spasticity and Fatigue

Muscle relaxants may be prescribed if stiffness is present.
Practicing mindful speech and pacing conversations can reduce tongue fatigue.
Hydration and nutrition support better nerve function and reduce discomfort.

🍴 Adapt Eating Habits

If swallowing is an issue:

Eat softer, moist foods.
Take small bites and chew slowly.
Use gravity-assisted positions (like leaning slightly forward).

💊 Disease-Modifying Therapies (DMTs)

By reducing inflammation and slowing MS progression, DMTs can help prevent new lesions that might affect tongue control.

Common DMTs include:

Ocrelizumab (Ocrevus)
Fingolimod (Gilenya)
Dimethyl fumarate (Tecfidera)

Talk to your neurologist about which DMT suits your condition.

🪥 Maintain Excellent Oral Health

Because MS can complicate dental care:

Brush and floss regularly, even if your tongue feels numb.
Use alcohol-free mouthwash to avoid irritation.
Visit your dentist more frequently if you're experiencing symptoms.

🧘Coping Emotionally with Tongue-Related Symptoms

Let’s face it: difficulty speaking, eating, or tasting can feel embarrassing and isolating. It’s totally valid to feel frustrated.

Here are a few emotional self-care tips:

Talk about it: Let family and friends know what’s going on.
Join MS support groups where others share similar experiences.
Work with a therapist if symptoms affect your confidence or mood.

💬 "Just because you can't say something clearly doesn’t mean your thoughts aren't valid."

🧬 Ongoing Research and Hope for the Future

Researchers are actively exploring ways to repair nerve damage and improve cranial nerve health:

Remyelination therapies: Aim to regrow the myelin sheath.
Neuroplasticity techniques: Help the brain find new ways to perform damaged functions.
Non-invasive brain stimulation (NIBS): Being studied to improve dysarthria and swallowing.

Clinical trials are also examining how gut health, stem cells, and gene therapies might improve MS outcomes, including cranial nerve-related symptoms.

✅ When to See a Doctor

If you have MS and notice new or worsening symptoms in your tongue, mouth, or throat, seek medical help promptly.

🚨 Red flags include:

Sudden difficulty speaking or swallowing
Choking on food or water
Unexplained numbness or tingling that lasts days
Persistent tongue weakness or drooping

Early treatment can prevent complications and improve quality of life.

🧾 Conclusion

The tongue may seem like a small part of the body, but in MS, it can become a big part of your journey. From speech and swallowing to sensation and taste, MS can impact the tongue in surprising and challenging ways. But with the right support — medical, nutritional, and emotional — these symptoms can be managed effectively.

If you're experiencing tongue-related symptoms, don't ignore them. They’re not "all in your head" — they're part of how MS interacts with your nervous system. Getting help early can make a huge difference in how you feel and function. 💙

📚 References

National Multiple Sclerosis Society. (2023). Speech and Swallowing Issues in MS. https://www.nationalmssociety.org
Chiara, T. & Martin, R. (2006). "Speech and swallowing in people with multiple sclerosis." Physical Medicine and Rehabilitation Clinics of North America, 17(3), 853-868.
De Pauw, A., et al. (2002). "The role of cranial nerve involvement in MS speech disorders." Journal of Neurolinguistics, 15(1), 1–18.
Beukelman, D.R., & Yorkston, K.M. (2017). Communication Disorders in Neurological Conditions: Dysarthria in MS.
Multiple Sclerosis Association of America. (2024). Oral Health and MS. https://mymsaa.org