ALS or MS?

[LRR54]

I am 56 and was recently diagnosed with MS, based on brain and upper spinal cord lesions on 3 MRI's. The contrast MRI did not reveal activity and the spinal and blood work panels did not confirm MS, although the Dr. thinks my symptoms indicate MS.  I have had fairly profound left-side weakness for 3 years, causing me to trip and fall a lot, balance is bad, my reflexes are very exaggerated, the Dr. said I have Babinski's reflex, but I also now have visible atrophy of my left calf muscle.  The Dr. said MS doesn't do that, so he is having me back for some kind of electrical testing of those muscles.  Could ALS or one of its subtypes (PLS or PMA) produce lesions similar to MS?

[LRR54]

While my symptoms do seem to conform to ALS, the presence of the lesions on the MRI seem to preclude that, from what I've been able to research.  Could it be that it is one of the Progressive MS types?  My doctor is not very communicative and I tend to come away with more questions than answers.  

[Dr Sharma]

Hi there. Your symptoms could well conform to ALS. This causes muscle weakness and atrophy throughout the body caused by degeneration of the upper and lower motor neurons. Unable to function, the muscles weaken and atrophy. Those affected may lose the ability to initiate and control all voluntary movement usually. Cognitive function is spared. Subtle changes are picked up by detailed neurophysiological  testing which you are going to take. The earliest symptoms are weakness and muscle atrophy. Others are muscle fasciculation , cramping, stiffness of affected muscles, muscle weakness affecting an arm or leg, and slurred and nasal speech. Symptoms of upper motor neuron involvement include tight and stiff muscles and exaggerated reflexes including an overactive gag reflex and abnormal reflex called babinsky’s sign. Consult your doctor for considering this as your condition. Take care.

[Redilma]

I'm not sure on this, but I think muscle wastage can occur in MS, and not just after a long time of disuse of that particular muscle. To be honest what you describe could be many things; I think you'll just have to wait and see what the results say. Symptoms present differently with everyone and so do the opinions of doctors. It's routine that they will check all options as these things are so hard to diagnose and get right!! good luck I wish you all the best