I read with interest the recent report describing the requirement of partial glossectomy for lingual edema following an epileptic fit(1). I would like to share my thoughts on the importance of tongue biting in epilepsy.

Tongue biting, traditionally believed to be a specific clinical sign favoring epilepsy, is also reported to occur in syncope and psychogenic seizures(2). Lateral tongue biting (on the sides) is more specific for a diagnosis of true epilepsy as compared to syncope(2) or psychogenic seizures, where biting of the lip or tip of the tongue is seen(3). Nocturnal tongue biting (NTB) can rarely be the sole manifestation of epilepsy(4) and typically occurs in frontal lobe seizures.

In a recent study, 53% of those interviewed mentioned that they would put an object in patient’s mouth to prevent tongue biting (33% learned this from a local television program)(5). Therefore, educating the patient’s caregivers about methods of preventing tongue biting should form part of any effective epilepsy management.

Sudhir Kumar,
Neurology Unit,
Department of Neurological Sciences,
Christian Medical College,
Vellore, Tamilnadu 632 004, India.
E-mail: [email protected]