Comment ALS Versus Peripheral Neuropathies

[LowMac]

Doctor,

I welcome you to reply as I welcome anyone who may read this.

I'm one of MANY patients who were found to have neuropathy symptoms and because of the rare possibility of ALS being a cause via search engine reading, I began the neurotic search for confirmation against having it or another neuromuscular degenerative disease. Even after I started this trend and my neurologist even told me at least twice with firm conviction, that neither my symptoms nor my EMG - nerve conduction pointed to ALS, I still sought secondary confirmation through forums and more online search etc... Also, my having been found deficient in two major vitamins (D and E) and insufficient in B12, already gives an obvious cause of my peripheral neuropathy, as does my autoimmune thyroid disease. I also have the burning, stabbing, tingling sensations (sensory symptoms) not typical of motor nerve disease but more-so of typical sensory peripheral neuropathy (far more common).

Yes, ALS is a real disease, absolutely and though still rare, is more common than previously discovered. God bless those who have this life-altering and fatal disease and those that are less catastrophic but still life changing, such as MND and MS.

With this said, I have seen a trend in which statements are made to the effect on sites and forums: "muscle weakness can mean you have a neuromuscular degenerative disease" or that muscle twitching can mean this. While this statement is true, it could be balanced a bit more by adding statements to the effect that MANY THINGS can cause these and other symptoms, yes, even muscle atrophy (wasting) that are not one of these diseases.

I have found through more search - this time for info in regard to the function of sensory versus motor and autonomic nerves that "peripheral neuropathies" involving sensory nerves do cause muscle weakness. Examples: carpal tunnel syndrome, tarsal tunnel syndrome, sural neuropathy, tibial neuropathy, peronial neuropathy, median neuropathy, median neuropathy, etc...... This type can affect both sensory and motor nerves to muscles and remain isolated or affect several areas of the body (polyneuropathy) but still not be a neuromuscular degenerative disease.

The ones listed above having to do with the feet, ankles and upper legs, can cause muscle weakness in the areas, lack of muscle control in them and even muscle atrophy (wasting) and this would be a result of the peripheral neuropathy. The med sources that give info on these also mention "foot drop" and deformity from these affected nerves.

Same is true of the nerves listed above that affect the hand and upper-arm. I in-fact just spoke to a man last week who used to be a carpenter but began suffering carpal tunnel in his wrists and had to change occupations because he was literally losing use of his hands. He told me that he could barely hold up a cup of coffee due to the weakness and shaking in them. His resolved without nerve surgery.

Additionally, these medical sites list "muscle twitching" as a symptom of peripheral neuropathy.

QUOTE:
"Peripheral neuropathy produces symptoms such as weakness, muscle cramps, twitching, pain, numbness, burning, and tingling (often in the feet and hands)." (New York Presbyterian Hospital)

So why with things like diabetes (many times undiagnosed), nerve entrapment, nutritional deficiencies and in at least 25% of cases being "idiopathic" (no detectable cause), would the jump be made, sometimes even by online doctors that combinations of symptoms such weakness and muscle pain or twitching with tingling, etc... - might indicate something like ALS rather than saying to the effect that this disorder, among many others needs to be checked-for as an overall evaluation?  

Don't get me wrong, some medical people and layperson members do give this better-perspective type answer but I have seen some replies to posts by those fearing a terminal disease be answered with insensitivity. In fact I saw a post by someone who had muscle twitching in ONE LIMB and a reply to them that was to the effect: "that is concerning for ALS." Yet if you go to an e-health forum regarding muscle twitches and anxiety (MedHelp is by far my favorite med forum), people by the hundreds are experiencing muscle twitches, anywhere from one limb to body wide.

If one wanted to go this far, they could even say that ALS or any other terminal illness is a possibility in ANYONE, regardless of symptoms or even if they have no symptoms. That would actually be a true statement as well but it certainly lacks perspective doesn't it!

[LowMac]

Whoops, sorry Doctor, I meant to specifically mention that you gave me the best perspective answer I had gotten from anyone, when I asked you about my muscle weakness and other symptoms. You gave me a list a many possibilities rather than simply pointing to one possible or the rarest cause. I even quoted you to another doctor.

For that I thank you very much!