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What else can UMN signs mean, if not ALS
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What else can UMN signs mean, if not ALS

My symptoms started over a year ago, with 'jelly thighs' after heavy exercise, and decreased strength and mobility in my left hand--I was dropping things and finding it hard to clip my nails, etc.  Finally saw a neurologist in August with a diagnosis 'hyperreflexia' and spasticity (stiff leg muscles) on my left side.  I also have a lot of twitching but it hasn't been observed in a clinical setting (so apparently is doesn't exist for them?).  Also my left hand and, to a lesser extent, my right hand, are very weak first thing in the morning, but regain strength quickly, however 'clinically' I show no signs of weakness.  My left calf is tight (spasticity I guess) making it awkward to walk at first, but my thigh muscles don't seem to be affected in the same way.  I also have weird 'tight' and tingly-like feelings in both my left and right calf muscles, and sometimes my forearms feel tight.  Oh, an another odd thing, a few times this summer I noticed my left and sometimes right hand were purple and cold, and other times white, suggesting some circulation issue.  I have always had an issue with cold hands and feet.

Anyway, recent EMG/Nerve Conduction test showed no abnormalities; MRI 'clean'; Numerous blood tests for just about everything--vitamin deficiencies, lupus, lyme's, thyroid, parathyroid, other autoimmune diseases, etc, etc.  Currently waiting a second opinion at a larger neuro-muscular hospital because my neurologists don't know what's going on and are only offering a 'wait and see' approach.

Questions:  
1. What do ALS fasiculations look like, i.e. are they everywhere in a random pattern, or constant and/or concentrated in certain affected muscles, or something different?  
2. Do ALS fasiculations mean that the muscle should already be weak or is about to get weak or something different?  
3. I notice less twitching at night (I don't wake or notice many in the middle of the night) but notice twitching and strange muscle sensations as soon as I wake up, or if I'm stressed.  Is this compatible with ALS muscle issues?
4. Is it a Typical ALS feature to have weakness in the morning that goes away completely soon after waking up?
5. In ALS, how long does it take before weakness shows up in an affected limb?
6. Is it possible that I could just have an UMN issue that doesn't progress?  
7. Do any UMN issues resolve on their own?

Any more information you can provide would be appreciated.


Tags: ALS, not?, what ??
351246_tn?1379685732
Hi!
I am sorry to hear about your medical problems. ALS fasciculations can be localized or generalized, but usually weakness of muscles and fasciculations affect the same area, usually a limb. Fasciculations are usually a sign of lower motor neuron disease, and occur due to depolarization of a lower motor neuron causing twitch in the skeletal muscle being supplied by it. Usually EMG is diagnostic.
How far and how soon the symptoms will progress is difficult to say. Also, on net it is difficult to ascertain whether you have upper or lower motor neuron disease or a combination of both.
Other diagnoses to be considered with upper motor neuron features are multiple sclerosis, stroke, traumatic brain injury and cerebral palsy. Please consult your doctor regarding this. Take care!

The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.
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