Re: Bulbar Problems

Posted By Suzette on February 05, 1999 at 18:16:35:

In Reply to: Re: Bulbar Problems posted by CCF neuro MD MM on February 05, 1999 at 15:40:05:






: : I have read that ALS can present with generalized fasciculations. I have two questions. One, would these generalized twitches be associated with a bulbar presentation of ALS?( I have no weakness,just fasics.) Second, could you describe in some detail what symptoms one might experience in the early stages of bulbar onset. ( I have read speech and swallowing dificulties, but this is a little vague, I have only a feeling of "fullness" in my throat) Thank you for your time.
:



: ALS can be predominant in one area, but usually some manifestations are
: widespread so usually bulbar symptoms would be associated with  
: widespread fasiculations.
: Bulbar problems involve severe, progressive worsening in speech ad swallowing.
: The swallowing problems often present with slowness of eating, then
: choking on certain foods and eventually inability to swallow.
: This is a motor not a sensory phenomenon so a vague feeling of fullness
: without swallowing problems is more likely to be due to anxiety than to
: ALS.
: trhe speech problems initially compromised consistent difficulty with
: articulation and eventually complete loss of speech.
Thank you for your response.   If you could clarify a few things for me,please. Are you saying that even with ,say, limb onset ALS, that some of the manifestations can occur in other areas of the body and that widespread fasiculations could point to bulbar involvement? Or that bulbar onset can present with widespread fasciculations as an early sign? I have had these twitches for seven months now, with two normal exams by my neurologist.I am really scared.I have no swallowing difficulties and only occasional feeling of fullness in the throat and some what I percieve to be tongue-"tiedness" on certain occasions,usually involving stress.




Fasiculations point to problems only in the area where they are found,
they may be found as an additional feature in ALS of bulbar onset and
are always found when the limbs are involved.
If you only have fasiculations, no weakness, two normal exams and only a
subjective sensations of fullness in the throat then I do not think the
combination points to ALS.
The bulbar problems do not come and go , they are constant and progressive,
your problems in this area sound more like a manifestation of anxiety than
ALS.
Bottom line then, bulbar onset ALS presents with bodywide fasciculations?? Thank You.