Worried about ALS

[Delos]

I am 58 years old. In March 2004, I noticed a slight atrophy of my left quadricep. In August 2004 I had frequent fasciculations in both hand that lasted 5 days only. Following that I had widespred fasciculations that occured dayly but not frequently.Since Auigust 2004 the atrophy in my left quadriceps has gotten worst with moderate weakness. I have also developed mild to moderate atrophy and weakness in my hands and forearms. I have had 5 EMGs since August 2004 (late August,  late October, December 2004, January amnd March 2005. All were normal except the last one who showed complex repititive discharges in my lef quadriceps. No fibs or SW were reported and the MUAP were normal in appearance NCSs were normal. MRI of the spine showed stenosis of the foreamen at C5 and C6 bilateraly, C7 right and L3 left and no canal stenosis.My neuro Has not given me any diagnossis. Cl;inicaly it looks like ALS. Is it possible to have ALS and not have the classical EMG sings over a period of more than 8 months?. At age 14 I had a foot drop that got progressively better and the doctor I saw told my mother that it might be a mild cae of poliomyelitis. Can I have post polio syndrome?

Thank you

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

My advice is limited as I have not seen you or your results. I cannot confirm if you really have wasting and muscular objective weakness of the left leg, and both hands/forearms. The El escorial criteria for ALS generally require evidence of ALS in 3 limbs and/or bulbar involvement by clinical exam or EMG. You do not seem to have any of the EMG criteria, which is also unusual if it really was ALS, and may indicate another pathology. Widesprad fasciculations are more suggestive of an ALS cause if early also.

There are mimics of ALS, and ALS is a rare disease, so the diagnosis should be made with caution. Forinstance, it is possible that vertebral disc disease may be causing both your hand weakness wasting and fascic and the left quad weakness (supplied by the L3 root). A syrinx or other spinal cord pathology should also be excluded by MRI of the spine.

Early polio can presidpose later in life to muscle weakness and wasting (classically asymmetric or unilateral) as your motor units naturally die off. Usually there are changes in the EMG in this area though (?I do not know if this area was specifically tested).

Make sure you have a general medical checkup also, especially if you have lost weight for no apparent reason recently.

An opinion from a center experienced in ALS could also help decide on a specific diagnosis, the Cleveland Clinic is one of several ALS centers

[Delos]

I forgot to mention that I have cramps in both quadriceps worst on the left side when I exercise or walk for a few hours. I also I a slight difficuty swalloing (small particules of food get stuck in my throath). All the blood teats were normal

Delos

Thanks

[Delos]

I have another question. Could the atrophy in my lef quadricep and in my hands and forearms be caused by the spinal arthrosis that is causing stenosis of the foramens at different levels? I don't have any radicular pain. My reflexes are symetrical though a bit brisk and I have no abnormal reflexes.Also, can sponsylosis iof the cervical spine cause fasciculations and if so are the fasciculations limited to the muscles that are inervated by the affected cervical roots?

Thank you