Muscle atrophy without diagnosis

[sunnygal]

I have had neuro symptoms of chronic muscle fatigue (weakness?) in my arms, thighs, legs, hands, twitching in different areas, and esophageal motility disorder, to name a few.  I have a difficult time sustaining energy at the gym to work out.  I have muscle atrophy in my left hand (dr has mentioned it), and facial asymmetry (left cheek is sunken in).  My ankles have thinned so much that I have to buy sneakers that have the extra top hole and wear thick socks, to keep the shoes on tight enough.  I have had several EMG's since 2002, the latest being in January 2006 by a Physiatrist.  She tested my tongue, thoracic paraspinals, the atrophied area in my hand (hand a little bit of a hard time getting the area to activate, but, it was ok, I guess), a couple of spots in the back of my shoulder, by my hip, inner knee, calf, and foot.  She said it was normal.  The physiatrist is stumped because she can see the asymmetries I am speaking of, but, doesn't have any answers.  At this point in time, do you think I can safely rule out MND? Any ideas of what might be going on?  Myasthenia Gravis, or some type of muscular dystrophy?  Thank you for your expert input.

[CCF-Neuro-M.D.-PW]

I cannot give you a clinical diagnosis over the internet, as this site is purely educational. That being said, if you have not seen a neurologist with specialty training in neuromuscular disease, you would benefit from seeing one. They are the best people to do the nerve conduction studies and EMG and interpret them in light of your symptoms and signs - EMG can be quite subjective and operator dependent.

Whereas MND can cause muscle weakness, wasting, and twitching, a number of other disorders can do this as well such as peripheral neuropathies, myopathies, and other disorders of the motor cells in the spinal cord (some viral and inflammatory disorders). Muscular symptosm associated with other organ disorders like esophogeal dysmotility, hearing loss, vision loss, etc can be due to mitochondrial malfunction - the part of body cells that is like the energy burner for the cell. This can be evaluated with a muscle biopsy with electron microscopy, and sometimes a blood test. Asymmetries and thinning of the lower legs can relatively commonly be due to Charcot-MArie-Tooth disease - a genetic disorder of peripheral nerves that is diagnosable by a blood test. Ask your neurologist about these possibilities.

Good luck

[sunnygal]

Also, I just went to PT today for fluid on my knee.  He said that my ankles are very unstable...I cannot squat down, or stand on one leg and lift the other at a 90 degree angle and stay balanced.  If I put my heels on a 2x4 I can squat farther down.  The PT said some of my muscles are doing all of the work for muscles that are not being used.

[cindymarie]

I hope somone responds to sunnygal. I, too, am having muscle atrophy in my left hand, plus visible "dents" in my left upper arm, left side along the lattisimus dorsi, left shin, and 3 spots in my left thigh. They biopsied the upper arm and only got "mild, myofiber atrophy". I recently had an EMG but the neurologist didn't explain it because he was focusing on the brain MRI that showed 6 small lesions in the right temporal lobe. He felt they were probably due to arterial disease, but he was ignoring my left side weakness and atrophy, plus the fact that I am a 42-year-old female whose blood pressure averages 100/68. I also am having swallowing issues. I choke or start to choke on water or my own spit three to four times a week. My primary care doctor suggested a barium swallow test, but I wanted to put it off.

[tormod]

I have Myotonic Dystrophy, problems you both describe are similar , swallowing , weakness, twitching etc. Do you have trouble "letting go" of things in your hands ,cardiac irregularities &/or cramping ? If so ,it's worth mentioning this to your Neurologist.