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Neurology (Expert Forum)
Interit Bulbar ALS from Father with Non-Bulbar?
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Interit Bulbar ALS from Father with Non-Bulbar?
by Betsy57, Jul 10, 2005 12:00AM
My father was diagnosed with ALS in his fifties: lived about 28 years to age 79. Diagnosis later changed to motor neuron disease, supposedly because he lived longer than ALS patients. His was the type that started in the extremities. I am 48 y/o female with history of depression, asthma and most recently hypothyroidism. Meds per day:900 mgs lithium, 100 mg elavil, 450 mg wellbutrin and, starting 3 wks ago because of hypothyroid diagnos, .05mg synthyroid. Clonezapam in small dose as needed for anxiety (average 1 or 2 per month). No Clonez. in past month.I have had difficulty swallowing saliva and liquid for past week or so;no difficulty swallowing food. Difficulty swallowing is hesitation of tongue at back of mouth, as if tongue's movement of liquid toward throat is out of sync with closing of epiglotis, as if I must concentrate to make them coincide.No choking, coughing or aspiration. I have tremor in hands sometimes.Sometimes muscle twitching in arms, legs, trunk the past week or so.Twitch is pronounced, e.g.,limb makes quick twitch moving 1 inch or so and then relaxes quickly.No noticeable atrophy or weakness of muscle.Tongue strong--can move up, down, to either side; can push against cheeks. Extremities strong.Reading this site middle of night, re tongue undulating as symptom; stuck my tongue out, midline of tongue moved down, then up, then down, etc.Right edge of tongue sore as if bitten in night. Can I inherit (or have) bulbar if my father's started in extremities? Other explanation? Lithium/elavil reason for twitch? Synthyroid reason for dysphagia?
Doctor's Answer
by CCF-Neuro-M.D.-PW, Jul 12, 2005 12:00AM
Twitches in the absence of objective muscle weakness or wasting is unlikely to be due to ALS. Widespread twitches are more likely to be benign especially at onset. Twtiches can also be caused by cold, exercise, sleep, certain medications, and sometimes pinched nerves or rarely viral infections. Lithium commonly causes a hand tremor. Swallowing difficulties should first be evaluated by a GI doctor first before assuming a neurological cause unless other neurological symptoms are present.
ALS is inherited in only approx. 5% of cases. Even known inherited forms of ALS are only passed to offspiring in less than 50% of cases. Therefore the odds are much in your favor that you do not have ALS. Motor neuron disease is the same as ALS - no difference. There are subtypes such as progressive lateral sclerosis, progresive amyotrophy, and bulbar ALS. We do not know if these subtypes have different disease mechanisms or genetics. You should follow over time with your doctor if your symptoms persist.
Good luck
ALS is inherited in only approx. 5% of cases. Even known inherited forms of ALS are only passed to offspiring in less than 50% of cases. Therefore the odds are much in your favor that you do not have ALS. Motor neuron disease is the same as ALS - no difference. There are subtypes such as progressive lateral sclerosis, progresive amyotrophy, and bulbar ALS. We do not know if these subtypes have different disease mechanisms or genetics. You should follow over time with your doctor if your symptoms persist.
Good luck
GOOD LUCK