Re: MS or ALS

Posted By Said on June 08, 1998 at 18:05:30:

In Reply to: Re: MS or ALS posted by CCF NEUROLOGY MD/in on June 07, 1998 at 22:53:27:






I have noticed the following problems:
Sometimes the knee(s) buckle under my weight, especially as I descend stairs.
Can not run, or jump arround.
Difficulty in getting up when seated on the floor. Has to usehands to get up.
Have pretty brisk reflexes.
Have back pain,ususally in the waist area.
Legs have sudden movement at night while sleeping.
Clumsiness in walking; sometimes the right toes drag on the floor.
Besides the above I feel OK.
Have done MRI of brian (normal), thoracic spine (normal), cervical spine (minimal degenerative narrowing and desiccation of the C5-6 disc without protrusion; otherwise, normal).
Have done visual and hearing tests (both normal).
Have done somatosensory evoked response (abnormal somatosensory evoked response of the posterior tibial nerve, right greater than left.)
Have done two spinal taps (result: normal).
So far, no clear dignosis. I am going for an EMG test soon.  
I have been distressed very much as I think about possibilities such as MS or ALS.  One other thing I've noticed is that I smile uncontrolably.
Could this be MS or ALS?  Would not these tests rule in or out the diseases?
Any insight would be appreciated.
Thanks
P.S. Being stressed makes my walking problem much more worse.




Dear Said:
It is very tough to tell you a definite diagnosis based on the information you gave us. The fact that brain, cervical and thoracic MRIs are normal, and spinal taps arenormal, makes the diagnosis of MS unlikely.
The diagnosis of ALS is a diagnosis of exclusion and may be confirmed/or ruled out by the EMG test you are scheduled to have.
The fact that you smile uncontrollably makes me think of a problem in your brain (but you said your brain MRI was normal, was it done before the uncontrollable smiling started?)
Otherwise, it seems that your problems are more localized to your lower extremities.
Therefore, the possibilities include but not limited to:
1. Lower back disc problem
2. Vitamin deficiency (such as vitamin B12 or E deficiency)
3. Zinc deficiency
4. Freidreich's ataxia among others.
I would suggest that you get a second opinion with a neuromuscular specialist to review your situation in details and to schedule you possibly for  more tests if needed.
If you desire to get an appointment at the Cleveland Clinic, please call 1 800 CCF CARE
Good luck