question about potential bulbar onset

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New member
Aug 16, 2022
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Hi everyone, I would very grateful for any insight or feedback about some symptoms I've been experiencing. I am concerned this could an early manifestation of ALS bulbar onset. I've been hesitant to post but I think feedback from a community that is familiar with these symptoms would be so helpful.

In March 2022 I began experiencing tingling and fasciculations in my right cheek/jaw bone along with headaches, nausea, extreme fatigue and dizziness; I also had pins and needles and cramping in right leg/arm. A week later these sensory symptoms were replaced by widespread muscle fasciculations (including tongue) that remain today. A saw a neurologist who conducted an exam and did an MRI, lumbar puncture, EMG/nerve conduction study (right leg/arm) and bloodwork. All were normal. I was diagnosed as benign fasciculation syndrome and moved on with my life.

In July 2022, after an incredibly stressful month at work, the cheek/jaw tingling returned with right eye pain, headache, etc. except this it felt like my jaw was misaligned or unstable. A few days later I started hearing a slurring sound when I say certain SL or CL words; my TH's and S's sound like I've developed a lisp; my F's sound strange as well like my upper lip is flapping when I say it. I also have scalloping on my tongue (worse on right side) and hypersalivation. My dentist gave me a night guard but it hasn't made much of a difference. I went back to the neurologist but he was a bit dismissive about it and said if it was ALS I'd sound like I was drunk when I speak and my family would hear a clear difference (they don't hear any difference, but I hear it and feel it). He agreed I had some very mild dysarthria and to return if I had swallowing issues. My questions are as follows:

(1) Can bulbar onset be unliateral? The slurring and tongue issues I have described are only on the right side. My left side feels fine.
(2) Is early slurring in ALS bound to only certain sounds, or does it affect all speech?
(3) Does anyone know if an EMG can be used to diagnose bulbar onset?

Thank you in advance for reading this and for taking time to respond and offer insight.
Hello there- sorry your online searches have brought you here.

If you will have a read here: Read Before Posting you will find a lot of information about ALS and commonly searched for terms such as twitching and sensory issues. You will note sensory symptoms such as tingling, pain, etc, point away from ALS and to something else. As well things like nausea and dizziness would seem to indicate something other than a condition that affects motor neurons.

Yes, EMGs can be used to detect bulbar issues related to ALS.

You will have to go back to your doctor in order to find more answers, but things would seem to point away from ALS.

Please take care.
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My mom has bulbar als. Diagnosed this past winter. She noticed that the left side of her tongue/face were affected 1st and her right side felt fine. Her 1st symptoms were slurred speech. It didn’t happen all the time initially, just occasionally. Then it happened more frequently. Her voice also became nasally. Her 1st EMG done in November was completely normal (including her tongue). They still suspected ALS given her symptoms and she got a 2nd opinion at Mayo which confirmed it.
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