MS, ALS, vascular, or nut case?

  Four neurologists have basically said I'm nuts.  But right or wrong, that isn't the explanation of my symptoms!  18 months ago I noted a slight weakness around the left side of my mouth and an equally slight weakness in the left hand little finger.  For several months prior to this I had dizziness and visual blurring.  For a year or more before this, I noted urinary urgency that was checked by a urologist and found not to result from prostate hypertrophy (I am 55 BTW).  Over the last year and a half my symptoms have progressed to frank dysarthria and more weakness in the left hand.  I have had had intermittent fasciculations that are worse than the long-term twitching I have been plagued with since age 21 or so.  I had a short (two month) period of burning pain and simultaneous numbness in my left forearm.  Quite numb and quite painful, primarily when touched or moved in a certain way.  After that (recently and to some extent still) my left thigh just above the knee went numb.  The left side mouth symptoms have spread to the tongue, which seems weak and strains when I speak for several hours (as I do in my job).  I have been terrified of ALS ever since Thanksgiving, 1996.  Two EMGs (7 and 15 months after first symptoms) were completely normal (and valid: these were done by the head of the department at a major univ. hospital).  MRI of brain a year ago and cervical spine last month were normal except for "reverse lordosis" but "no clear herniation."  I neglected to note my Lhermitte's sign, if that is what it is (I described this to you earlier and learned the name).  Although worst when I bend the neck forward, it happens even when I breathe in (but not all the time).  My current neurologist (actually the one I first consulted) has ordered some new tests in order to placate me.  My question is: based on the symptom history above, which are most important, given financial constraints.  Evoked potentials, another brain MRI, a lumbar spine MRI, swallowing study, and paraneoplastic tests are on the menu.  What is most likely here and what to do next?
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It is difficult to say exactly what is going on. It is reassuring that your tests have been normal, but I couldn't advise a specific next test (especially if only one can be picked) without an in-person interview and examination, as well as review of all data available.
The first task is to figure out where in the nervous system your symptoms are coming from. ALS and MS are completely different diseases, not only in the pathophysiology but what part of the CNS is affected. I would be very doubtful of ALS, given the symptoms you describe.
Some of the symptoms (Lhermitte, some of the numbness and weakness pattern) suggest involvement of the cervical spine. If there is MORE THAN ONE location within the central nervous system involved, then MS would be reasonable to consider. If there is ONLY ONE location involved, then think of degenerative spine disease (good old fashioned wear and tear). The reverse lordosis actually makes me think of that more than MS.
I wish I could give you a mroe definite answer, but it's just not possible in a forum such as this. Nevertheless, I hope this helps clarify some issues. Any specific comment regarding diagnosis, treatment options, and prognosis must come from your physician. If a second opinion would be helpful, you are welcome to call 800 223-2273 and ask for neurology appointments. CCF MD mdf.