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Neurology (Expert Forum)
ALS concerns
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury
ALS concerns
by laurajh, Apr 13, 2005 12:00AM
My fatherinlaw has had pain in 1 thigh for about 2 months. It's not constant, he feels good when he gets up in the morning but after too much walking it comes on & can be sharp, & is relieved by rest. He’s active, not vigorous, but always going places, doing something. He’s 75. Hasn't mentioned any weakness or twitching, just pain which stayed the same for 2 months without progression. His dr referred him to a neuro thinking it might be sciatica, and he DID have sciatica 10 yrs ago which cleared up on its own. I thought sciatica involved steady pain, not intermittent, & not even alleviated by rest. No problem sleeping.
Had MRI (no results yet) & the neuro did say reflexes are normal on one side, less on the other. That scares me most.
The reason I worry is because in his family ALS is genetic, 3 generations affected. He’s had circulation problems in the leg twice (2 arterial bypasses.
I've read it's odd for ALS to 1st present itself so late in life, but 1 of his sisters was 70/71 when it hit (died before turning 72). I read that pain is not typical, at least not until muscle wasting which causes cramps is well under way. He has no noticeable weakness/wasting. I've also read that symtoms typically start in the hands or feet and work their way in, not starting in thigh.
He's had physical therapy a few weeks, being hooked up to a stimulator 15 mins twice per week. EMS or TENS (unsure), is used to stimulate muscles or nerves and is said to alleviate pain, but hasn’t helped. I realize this is no substitute for examination, but your professional opinion is valued.
Had MRI (no results yet) & the neuro did say reflexes are normal on one side, less on the other. That scares me most.
The reason I worry is because in his family ALS is genetic, 3 generations affected. He’s had circulation problems in the leg twice (2 arterial bypasses.
I've read it's odd for ALS to 1st present itself so late in life, but 1 of his sisters was 70/71 when it hit (died before turning 72). I read that pain is not typical, at least not until muscle wasting which causes cramps is well under way. He has no noticeable weakness/wasting. I've also read that symtoms typically start in the hands or feet and work their way in, not starting in thigh.
He's had physical therapy a few weeks, being hooked up to a stimulator 15 mins twice per week. EMS or TENS (unsure), is used to stimulate muscles or nerves and is said to alleviate pain, but hasn’t helped. I realize this is no substitute for examination, but your professional opinion is valued.
Doctor's Answer
by CCF-Neuro-M.D.-PW, Apr 15, 2005 12:00AM
Sciatica can cause intermittent pain in the buttock and posterior leg area, that sometimes shoots down from top to bottom
As the compression of the sciatic nerve may be positional, (made worse in certain situations) the pain can be intermittent
Also, lack of blood supply to the nerve/upper leg can cause pain on walking/exercise in that area too - for example due to peripheral atherosclerosis (hardening of the arteries) or diabetes - these should be evaluated for
Leg pain without other features of ALS - wasting, fasciculations, weakness, an abnormal EMG, is not suggestive of ALS. The vast majority of ALS is sporadic (that is, not genetic) so just because his sister had it, this does not make him much more likely to have ALS. A decreased reflex on one side is very non-specific and may be consistent with a peripheral nerve compression/problem.
Good luck
As the compression of the sciatic nerve may be positional, (made worse in certain situations) the pain can be intermittent
Also, lack of blood supply to the nerve/upper leg can cause pain on walking/exercise in that area too - for example due to peripheral atherosclerosis (hardening of the arteries) or diabetes - these should be evaluated for
Leg pain without other features of ALS - wasting, fasciculations, weakness, an abnormal EMG, is not suggestive of ALS. The vast majority of ALS is sporadic (that is, not genetic) so just because his sister had it, this does not make him much more likely to have ALS. A decreased reflex on one side is very non-specific and may be consistent with a peripheral nerve compression/problem.
Good luck