ALS s/s

My father died of ALS at age 33.  Since then several of his brothers and sisters also died of ALS.  I am 55 years old.  I've had difficulty clearing my throat for about a year.  for the past week I've had a tightening in the index finger of my right hand.  It feels like it's drawing up or something.  I am diabetic, have hypothyroidism and high cholesteral.  I take meds for these.  I also feel fatigued most of the time and feel I could sleep for days.  Are any of these symptoms related to ALS?

[Esteban Cheng-Ching, MD]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

ALS  (Amyotrophic Lateral Sclerosis) is a neurologic condition that leads to loss of motor neurons in the central nervous system, and degeneration of the tracts connecting these neurons throughout the spinal cord. It can affect different levels of the motor system. When affects the bulbar region it leads to problems talking, swallowing, and the tongue. It also affects muscles of the arms and legs, and even respiratory muscles. Other symptoms include weakness, but objective weakness (not only feeling tired), the muscles become atrophic or smaller, and “fasciculations” are noted (muscle fibers “jumping” inside the muscles, this being visible and not caused by other conditions). Many patients are alarmed by the presence of fasciculations, but these could be caused by other conditions such as excessive caffeine, or anxiety. However in the context of the other manifestations (but not alone), fasciculations should be considered seriously in order to make the diagnosis.
The diagnosis is many times difficult, and a good neurologic exam with electrophysiologic testing are required to make the diagnosis. There are specific criteria that needs to be met in order to make the diagnosis, and so it is very important to have a diagnosis made by a Neurologist.
Sensory symptoms are not typical in ALS, and ALS is classically a motor disorder, commonly sparing the eyes, and as well as bladder and bowel function.
In your case, the symptoms of “difficulty clearing the throat” is nonspecific but could be present in patients with ALS. Tightening of the fingers is a sensory symptom, and this is not common in ALS. The generalized fatigue and tiredness is also nonspecific, and could be from ALS, or it can be present in ALS and it may not be related to it.
ALS can be sporadic (no family history), or could be familial, and there are multiple genetic abnormalities that can lead to familial ALS, but the exact cause and mechanism of disease is still not 100% understood.

I understand your concern as it seems that there is a cluster of ALS in your family.  Because of this, and not specifically because of your symptoms, I think that you should see a Neurologist, have a detailed neurologic examination, and if considered necessary, have electrophysiologic testing.
Based on what you tell me and without the ability to examine you, I really cannot tell you what you have, or if your symptoms are associated with ALS, however it is very important that you see a Neurologist to rule out this possibility or make a prompt diagnosis.

I hope you find this information useful. Thank you for using the forum, good luck.