ALS or Cervical Myelopathy

I had a diagnosis of ALS 5 months ago.
Symptoms;
Fast Reflexes
Fasciculations: Arms, Chest & Legs
Muscle wasting and loss of some functions of Hand.

Note: I think that the diagnosis was way too quick.

After the diagnosis I had an EMG which showed normal nerve conduction ( except denervation of the arm I think ?)
An MRI of the spine showed a herniated cervical disc C6/C7 with Osteophyte formation, though not causing an obvious radiculopathy.

I started to develop sensory symptoms: Intermittent Pins & Needles in Hands and Feet and electric shocks & "sharp pins" into feet and rest of the body, especially when moving head & neck.
Note: I had a painful stiff neck.

I went onto Non Steroidal Inflammatories 2 months ago and have had a definite improvement (small)in my hand and the pain in the neck has gone.

What I think could be happening is that the area around C6/C7 is swollen affecting the nerve(s) to my hand & arm and also pressing on my nerve roots & spinal cord to cause the fasciculations below the level of my arms.

Is this possible ??

All my symptoms ( Hand and fasciculations) seem to vary with my neck position ( worse with head forward).
Note: The MRI was done with my head back, could it show something different with my head forward ? e.g Osteophyte protruding into spinal cord etc ??

I have been told by the Neurologist that I would have to be compressing quite a few of the nerve roots in my spine to get fasciculations in arms and legs.

Is this true ??

I believe that with ALS, fasciculations happen when control of the muscle is lost and therefore it would become apparent quite quickly...i.e weakness would be noticed ??

How long does it take for weakness to become apparent after fasciculations have started ??

After 5 months I seem perfectly normal in the rest of my body (except for the fasciculations which can be quite intense) and I have had  a small definite improvement in my hand.
I haven't lost weight and do not get tired.

What do you think ??

[Abhijeet Deshmukh, MD]

Hi.

The weakness may come six months to one year after the onset of fasciculations ! And an improvement is very rare in ALS.

It is true that an extensive area of the spinal cord has to be compressed to get fasciculations. But, changing severity of symptoms with changing position of the neck does point towards a more probable cervical problem.
In this case, you may consider a second opinion.

All the best.

DrAbhijeetMD

[Jack104]

Dr Abhijeet,


Thanks for your reply.

I have read that a cervical myelopathy can cause fasciculations in the lower limbs as well as the upper limbs, but that it is not usual / rare.

I thought that the cause of fasciculations in ALS was loss of control of the muscle.........so surely you would notice something ??

My improvement started after I took antiinflammatories, so I'm thinking it's too much of a coincidence.

[h1ns]

"All my symptoms ( Hand and fasciculations) seem to vary with my neck position ( worse with head forward).
Note: The MRI was done with my head back, could it show something different with my head forward ? e.g Osteophyte protruding into spinal cord etc ?? ".

Jack,

Get an MRI while moving your neck forewards and backwards.
Flexion can cause the cord to be compressed and result in damage to the anterior horns.
And believe me, you don't want that to happen.

Hans Bregonje