Management of Mouth Numbness in Multiple Sclerosis
Mouth numbness in an MS patient represents a sensory relapse that should be evaluated for associated dysphagia and managed symptomatically, with corticosteroids reserved for functionally significant symptoms that impair quality of life.
Initial Clinical Assessment
Distinguish True Relapse from Pseudo-Relapse
- Confirm this is a new neurologic symptom lasting >24 hours without fever or infection, as pseudo-relapses (symptom fluctuations from heat, infection, or fatigue) do not warrant disease-modifying treatment 1
- Mouth numbness alone, while uncomfortable, may not require aggressive intervention unless it affects swallowing safety or nutrition 1
Screen for Dysphagia Immediately
- All MS patients with oral symptoms must be screened for dysphagia, as 36-81% of MS patients have swallowing dysfunction that can cause aspiration pneumonia, dehydration, and increased mortality 2, 3
- Use the Dysphagia in Multiple Sclerosis (DYMUS) questionnaire to assess swallowing for solids and liquids, which identifies 92% of patients with swallowing problems 2
- Ask specifically about: altered feeding habits, coughing/choking during meals, food sticking in throat, and difficulty managing secretions 2
Identify High-Risk Features
- Patients with cerebellar dysfunction, severe disability, or long disease duration are at highest risk for clinically significant dysphagia requiring instrumental evaluation 2
- Brainstem involvement can affect cranial nerves controlling both sensation and salivary gland function, potentially causing both numbness and dry mouth 3
Management Algorithm
For Isolated Mouth Numbness Without Dysphagia
- Observation is appropriate if the symptom is mild, not functionally limiting, and screening confirms safe swallowing 1
- Educate the patient that sensory symptoms often improve spontaneously over weeks to months
- Consider short-course corticosteroids (methylprednisolone 1000mg IV daily for 3-5 days) only if the numbness significantly impairs eating, speaking, or quality of life 1
For Mouth Numbness With Positive Dysphagia Screening
- Perform instrumental evaluation with videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallowing (FEES) to identify specific physiologic abnormalities 2, 4
- Modify food and fluid consistency immediately according to individualized swallowing assessment to ensure safe swallowing and prevent aspiration 3, 4
- Use thickened liquids or jellified water if delayed swallowing is identified 4
- Implement chin-tuck posture during swallowing, which provides airway protection by opening the valleculae and preventing laryngeal penetration 4
For Mouth Numbness With Dry Mouth
- Screen for dysphagia as these conditions frequently co-occur in MS patients 3
- Modify food consistency to soft, semisolid, or semiliquid states to compensate for reduced saliva and ease pharyngeal transport 4
- Consider that brainstem involvement may be affecting salivary gland innervation 3
Nutritional Monitoring
- Involve a dietitian for nutritional counseling if dysphagia is confirmed or if the patient reports altered eating habits 4
- Consider enteral nutrition via PEG tube if the patient cannot meet nutritional needs orally despite modified consistency foods 3
- Implement meal enrichment with high-calorie foods if intake is compromised 4
Common Pitfalls to Avoid
- Do not dismiss oral numbness as "just sensory" without screening for dysphagia—silent aspiration can occur even with mild symptoms 2
- Do not rely solely on patient-reported swallowing symptoms, as objective instrumental testing reveals dysphagia in 81% of MS patients versus only 36% by subjective methods 2
- Do not treat every sensory relapse with corticosteroids—weigh the risks of treatment against functional impact on morbidity and quality of life 1
- Do not delay dysphagia screening until severe disability develops, as swallowing problems can occur even in patients with low disability (EDSS <2.5) 2