ALS fears

[elise a]

My boyfriend is 43 with 7 yr history of degenerative disc (L4&5)problems causing muscle cramps (mostly hamstring & calf)and leg and lower back pain. Also weakness and loss of flexibility. In 2001 he had lumbar fusion of the L5 but never really regained mobility. In June '04 he noticed fasticulations in calf muscles, worse in right leg but also in left. Cramps and pain also worsened in right leg. I was immediately worried about ALS and got him to see Neuro dr who did H&P only and said "not ALS, related to back problems". We went home happy, but symptoms of pain,cramps,stiffness&fasciculation continued. I feel there is some loss of muscle mass in legs but possibly attributable to his 5+ yrs of back disability. He now has difficulty walking. There appears to be a cycle related to activity leading to pain leading to increased cramps and fasticulations. MRI is negative for impingement of nerves in back due to herniated L4 disc. He has just seen ortho dr who has diagnosed poss. sacro-illiac instability but also referred him to 2nd neuro for EMGs. I am completely terrified of the ALS thing and am wondering how reliable the EMGs will be for diagnosing it. Will the presence of cramp/fasticulation in the legs show as abnormal on EMG and will it be distinctive from ALS? I realize you can give little hope from afar but any words of reason would be appreciated. Thanks in advance.

[CCF-Neuro-M.D.-PW]

Fasciculations in the absence of muscle weakness and wasting is not suggestive of ALS
Muscle weakness and wasting should be confirmed objectively by a neurologist or other physician experienced in detecting these abnormalities

Fasciculations and cramps can also be caused by pinched nerves, and may be worse after cold or exercise

EMGs will show any active nerve damage (as is the case usually in ALS) but is less good at defining more chronic abnormalities (such as problems from chronically pinched nerves). Therefore EMG is more limited if these chronic changes are present, but may still be helpful in excluding ALS.

If necessary a 2nd opinion by an ALS specialist may be helpful in excluding the diagnosis. Dr. Erik Pioro at the Cleveland Clinic ALS Center is an expert in this area.

Good luck

[cranky]

I too had a herniated disc at L4-5 and due to a delay in surgery it resulted in cauda equina syndrome.  The disc was fused but my symptoms seem to have gotten worse instead of better.  I have bilateral drop foot and wear afo's to walk, but it seems that my weakness is progressing proximal to the original level and I have the most awful burning in my legs for which they perscribe neurontin.
I have had a myelogram which shows two minimal disc bulges and some central canal stenosis, I also had a cervical spine mri which showed two disc bulges and some central canal stenosis.
NCV/EMG shows progressive slowing of the peroneal nerves with a conduction block on the right.
My ortho thinks it's a neurological disease.
My neuro says it's coming from my spine.
Help!