Is this ALS?

I am a male, 46 years old. I am diabetic since 14 years and under insulin therapy.  
Complaint: Wasting, weakness in my right lower limb since 4 years.
Present history: it started 4 years ago by weakness and feeling of stiffness in my right lower limb specially the leg and foot. It progressed for two years and then remained stationary  till now. There are no similar signs in other part of my body. I can walk and climb stairs and my motor functions are within normal except for my right lower leg. Recently, I started to feel twitches in my right lower limb that is mostly at night and sometimes it disappears for days or weeks. I also feel it with less frequency in other parts in my body. I was seen by many neurologists who agreed on that is a localized lesion in my right leg and owning to the long duration it is less likely to progress.Two consultants denied the diagnosis of ALS and referred the case to my diabetic neuropathy status .Speech, swallowing and chewing are all normal together with my hand functions
Past history: Diabetes since 14 years under insulin with poor control.
Current medications: Cepralex 10 mg ,Lexotanil 3 mg, Aspirin tab, Coversyl 10 mg.
Family history : Irrelevant for similar condition. Father had Parkinsonism and was diabetic.
Investigations : ECG with treadmill: Normal findings.
Blood tests are all normal.
MRI - cerebral and spinal . Normal findings.
Needle EMG - Picture of motor and sensory neuropathy and chronic deinnervation  with one  fasciculation  detected in the right biceps ms only.
Habits: Heavy smoking  and coffee
Examination : right lower limb.
1- Muscle wasting  compared with the left lower limb.
2- Briskly knee jerk.
3- Babiniski sign is present denoting upper motor neuron lesion.
4- No fasciculation can be elicited by any examining doctor.
Neurological examination of the entire body and cranial nerves is NORMAL clinically.
Is this a case of ALS? What is the prognosis?

[Christopher R Newey, DO]

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 a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

It is difficult to say if you have ALS or not without more history, examination, performing an EMG (or at least reviewing EMG results). ALS typically has many features like what you mentioned such as twitches or fasciculations. These usually occur in the context of progressive loss of sensation, tingling or numbness, weakness, trouble swallowing and other symptoms. It is good that you have had an EMG. There are other causes of muscle twitches. One being what you mentioned with the diabetic neuropathy.

I would suggest you continue following up with your neurologist. You may need to have neuroimaging (MRI) of your brain given the upper motor neuron findings on your examination and history of poorly controlled diabetes.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.