Re: Weakness in ALS

Posted By Sean on April 26, 1999 at 10:01:52
Hi,
I'm a 28 year old male.
I've been fasciculating all over for a little over two months. It started in an arm and quickly spread everywhere (including abdomen, neck, back, etc.), but not tongue yet.
I had a negative EMG 17 days after my first twitch. Muscles in the leg I'm about to complain about below were tested. Also, have been through comprehensive blood work at a big University MDA clinic.
In the first month of my symptoms, I experienced a lot of roving stiffness and pain in forearms, back of neck, and elsewhere which seemed to last a few days and go. Most notably, though, was an acute attack of nerve and muscle pain affecting my left leg (felt like it was broken) which lasted about four days and subsided. I was encouraged that the symptoms early on were pretty transitory.
In the last month, however, concomitant with the widespread fascics, the left leg has really been affected strangely. Pain (like the muscles are strained or sprained) moves around the ankle, foot, and up the leg. Fascics are prominent. I can't really say that it's stiff, and I've really only had one real charley-horse-type cramp in the calf (been on 260mg Quinine). I can still run and walk fine, but the pain is bothersome, and has me thinking that weakness is beginning in this limb. I've been putting it through some paces I picked up from past neuro exams, ie., heel-toe rolling and walking. Weakness, if there really is any, is rather subtle. And, although I find the left leg to perform slightly worse than the right; I am right-side dominant.
I'm extremely worried that this leg has become the focal point of the problem. Is it common or likely that ALS would present like this; moving around for a month and picking a limb to start in? I have another EMG coming up later this week, and am pretty darn scared.
What do you folks think? I thank you in advance for your reply.
-Sean

[CCF neurology MD MM]

Posted By CCF neuro MD MM on April 27, 1999 at 10:37:24
There re a number of features which reasssure me that this is not ALS. The sensory symptoms for instance ( severe pain ) are very atypical as is the absence of weakness.
ALs is caused by death of motor nerve cells , so the weakness does not come and then go again, any weakness in a given area remains and worsens, the disease progessses relentlessly,it does not fluctuate from time to time and does not
move from limb to limb.
By the time you have fasicultations you would also have other signs of denervation on your EMG  ( fibrillations, insertional potentials ) these help,to distinguish ALS from benign fasiculations which is your problem , I suspect.
I think your next EMG should reassure you finally that this is not ALS so you should look to this as a source of reassurance rather than being scared.
There is no evidence to suggest that this is in any way linked to a
Gulf War infection, ( and I haven't been warned to say this ).











Follow Ups:


Weakness in ALS to CCF Neuro MD MM...thank you from Sean 4/27/1999
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Re: Weakness in ALS Elizabeth to doctor 5/04/1999
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Weakness in ALS Elizabeth 5/04/1999
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