Drop Foot both legs, 24 / 7 Fasciculations, Cramps

[gregobx]

I have had these symptoms for well over a month now. It started with cramping at night and then drop foot in my right leg around the end of April then moved into the other leg a week later and has not diminished. My legs are getting weaker and then the fasciculations showed up. I also have cramps in my calfs, feet and shin muscles mostly at night. My upper lip twitches and I get cramping under my jaw when I yawn. MRI on spine and brain did not show eveidence of demyelination and all labs are clean. The neuro surgeon is concerned about MS or ALS although it seems that MS has been ruled out now. I have an EMG scheduled for next week. I am 41 years old, male and no history of anything realted to MS, ALS or any other similar disease in family history. Does this sound like ALS?

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information

Muscle cramping with weakness in the legs and muscle twitching are in general a sign of a problem in the peripheral nervous system (the nerves where they start in the spinal cord, called motor neurons, all the way to their end at the fingers, skin, etc). If your symptoms have progressed this rapidly, over 4 weeks, then while one possibility is ALS, other possibilities include certain neuropathies such as what is commonly known as Guillan-Barre, or other similar types of neuropathies that are due to a problem with the myelin, the sheath that covers the nerve. If it is Guillian-Barre, this condition recovers well in most patients and is treatable. Other causes of rapidly progressive peripheral nerve problems include exposure to certain chemicals (such as lead). Finally, the problem could be not in the nerves but rather in the muscle, such as what is called viral myositis, or inflammation of the muscles due to a viral infection, or myositis of some other cause, often which is reversible. It is a good idea that you have an EMG planned for, this will test how the nerves conduct electricity and how the muscles respond and contract, and wil be able to help sort out the cause.

A problem with the central nervous system, brain or spinal cord, such as MS or others, seems less likely given the description of your symptoms but again I can not tell just based on your description. This would be elucidated based on your examination and on MRI of the brain and spine.

Follow-up with your physicians is recommended.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[gregobx]

Dr, Chahine,

Thank you for your response. I did have the NCS and EMG as well as a consult with my Neurologist yesterday. The conclusion was 1. Peroneal Neuropothy at the Tibial Head and 2. Periphial Neuropothy however the cause is still a mystery as all my labs have come back clean including a glucose tolerence testing today. My questions at this piont would be in trying to pinpiont a cause. I have not had any pain, tingling or typical numbness to speak of. I do have very slight numbness of the skin only on top of my big toe and above my ankles only about 4 inches above the lateral malleolus but i can feel pin pricks and fingernail tapping lightly and the numbness is only on the surface. My drop foot symptoms started appearing very suttle over the last year in the right foot only. I now remember tripping occaisionally when walking and tripping going up stairs. I have had problems with swallowing for a year now and i have been choking on my saliva and liquids real easily especially over the past 6 months. In addition i have noticed increased saliva when I talk to the piont of spiting while talking and my upper lip has been twitching. Agian this has been over the past 6 months. Then about 6 weeks ago it the drop foot became severe in the right foot and 7 - 10 days later moved to the left foot. Are these symptoms related or just coincidence? I am wondering how I would have the exact same conditon in both legs if this is a peroneal nerve problem. Is that common in this type of presentation? My other question would be in regards to cause. Is it possible that the drop foot and change in my walking led to the nerve damage as apposed to the nerve damage cuasing the drop foot? I did have some slight aching type of pain in the Tibila area several weeks after the drop foot showed up. I assumed it was strain from the way I walk now. I welcome your thoughts.