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Neurology (Expert Forum)
Could this be ALS?
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Could this be ALS?
by fpoknikr, Feb 22, 2001 12:00AM
Doctor,
I'm an acitve runner, 15-20 miles per week, and I've completed five marathons in the last six years.
Over the past year, my runs have been getting harder, and my times have decreased.
I have been having fasciculations for the past five months - initially they were in my lower legs, but they have progressed all over my body. The lower leg fasciculations are constant (multiple instances within any five minute span), while the others are intermittent (multiple instances within any hour).
My neck is stiff as I turn it from shoulder to shoulder.
I get frequent cramps in my feet and calves.
I have no problems with balance, or tripping, although my memory seems to be worsening - I have problems remember names, and problems selecting the appropriate word for a situation.
Are the symptoms those of ALS?
Thanks in advance for your time.
I'm an acitve runner, 15-20 miles per week, and I've completed five marathons in the last six years.
Over the past year, my runs have been getting harder, and my times have decreased.
I have been having fasciculations for the past five months - initially they were in my lower legs, but they have progressed all over my body. The lower leg fasciculations are constant (multiple instances within any five minute span), while the others are intermittent (multiple instances within any hour).
My neck is stiff as I turn it from shoulder to shoulder.
I get frequent cramps in my feet and calves.
I have no problems with balance, or tripping, although my memory seems to be worsening - I have problems remember names, and problems selecting the appropriate word for a situation.
Are the symptoms those of ALS?
Thanks in advance for your time.
Doctor's Answer
by CCF NEURO[P] M.D.-RPS, Feb 22, 2001 12:00AM
Dear fpoknikr:
I am sorry that your having muscle fasciculations. What your describing can be compatible with ALS or with other diseases. What is needed is a good neurological exam and if the findings of detected muscle weakness with both upper and lower motor neuron findings, no sensory involvement, and maybe an EMG study, then the correct diagnosis can be formulated. There are many other things that can cause cramping and muscle fasciculations. It is often difficult in assess running times as many factors can play into decreased running efficiency.
Sincerely,
CCF Neuro MD
I am sorry that your having muscle fasciculations. What your describing can be compatible with ALS or with other diseases. What is needed is a good neurological exam and if the findings of detected muscle weakness with both upper and lower motor neuron findings, no sensory involvement, and maybe an EMG study, then the correct diagnosis can be formulated. There are many other things that can cause cramping and muscle fasciculations. It is often difficult in assess running times as many factors can play into decreased running efficiency.
Sincerely,
CCF Neuro MD
I have been a runner for 23 years and have had similar progressive symptoms - gradual exercise intolerance during the last year. Fasciculations and brisk reflexes started 7 months ago - all over my body. Fasics are, however, most pronounced in my calves and soles of my feet. Had an LUE EMG in August of 2000 - normal. Went home thinking this is all anxiety. Started meditation, breathing, etc... Then in October cramping starts in quads. Still thinking this is anxiety. OK until November 6, 2000 - I look down and see new onset focalized atrophy about 3 cm x 1 cm in upper surface of lateral gastrocs/lateral soleus left leg. Needless to say, I emotionally lost it.
I made a trip back to my neurologist who was concerned - this atrophy was definitely new and not noted during August exam. He did a detailed emg using what I believe to be very good technique. Except for fasics in left thigh, the EMG was absolutely normal - even when he stuck needle in atrophied area. EMG is again repeated one month later - on December 4, 2000. Again completely normal. He suggests that I see an ortho doc - even though there was no trauma or tenderness in area.
Orthopod really gets me worried when he looks at my leg. "This is not orthopedic - do you have a family hx of ALS?" He orders an MRI of left leg. Mysteriously - the MRI on Dec. 12 is unremarkable. Shows no sign of atrophy. Ortho is baffled by this - because we can all (neuro, PT, me, ortho) feel a definite indentation and graininess in musculature. He suggests that I go to a regional neuro center such as Medical College of Wisconsin or Mayo. Mayo rejects my request to be seen. MCW agrees. Neuro at MCW decides to skip any more EMG's. She decides to have a muscle and nerve biopsy performed. To my suprise, this procedure is ordered for the right Vastus Lateralis and rt. sural nerve. (Atrophy is on left side). Biopsy results have just returned. They are absolutely normal.
One more note: Despite strenthening and stretching exercises for the left gastrocs/soleus, in the four months since the presentation of the atrophy it has not filled in. In fact, the atrophy appears to have slightly extended - the musculature around it has flattened out and the soleus is definitely palpable as much smaller than the right leg. There is no measurable weakness anywhere - though this does not surprise me in such a strong muscle group.
My questions are:
Can the absence of neurogenic changes on right thigh really give me a sense of reassurance that the left leg is probably not the result of ALS? I know that there are no guarantees...
If the atrophy were the result of ALS - would it be most probable that the emg performed one month after atrophy presented would have been abnormal in some way?
Thank you. My thoughts and prayers go out to the many other people who are worrying about similar symptoms. With the three combined symptoms, it has been quite an emotional time for me. Though I am thankful for all of the normal results, I am still quite concerned. My exercise tolerance is down to nothing. At best, I can run 1/2 - 1 mile very slow. Fasics are profound after this "jogging", as are crampy/achy sensations in bilateral quads.
Your site is a true blessing.
Sincerely,
Julie Klug