Distinguishing Upper motor Neuron disorder from Lower

[Geo]

Feature / Upper / Lower

Reflexes / Hyperactive / Deminished or absent

Atrophy / None or absent / Present

Fasici,s / None or absent / Present

Muscle Tone / Increased / Decreased or absent


This is taken from Merck Manual . Fasics are fasiculations ,or some call twitches .
Some here say they have weakness and have PLS ,this is problably Stiffness or the muscle unwilling to move . PLS is a Upper Motor Neuron Disease Only, no Lower Involved . Or i would say you dont have PLS . There are Lots of Motor Neuropathies
and one can be confused with others . PlSers are Blessed in a way ,We may not have a Quality of life but we get to live . Hope this helps someone . Geo

[arlie]

what is pls exactly iwas diagnosed with als -it is starting in my mouth-thanks-arlene

[APC]

Hi Arlie,
My husband was originally dx w/ PLS, Primary Lateral Sclerosis. This affects the upper motor neurons. Mainly arms,speech, hands. He then developed leg weakness. This whole thing started out with fasiculations/fasics. PLS seems to be the better of the motor neuron diseases to get. Some do progress into ALS,which my husbands has. It seems this form of the ALS is slower progression. With GOd's help it will remain slower progression. I hope this helps a little. APC

[juliesmile]

So if you are exibiting symptoms of both ie brisk reflexes, absent reflexes, and muscle atrophy you could't possibly have PLS.

[olly]

if you look at all the web sites on pls they will tell you that pls does cause progressive muscle weakness mainly from spasms.:neutral:

[olly]

i think that would be more in line with als.
geo, also it is possible to have minor lmn involvement in pls, iv'e studdied this alot as i have some lmn signs/symptoms, i have lots of articles on this if you want to read them.
my neuro gave me dx of a mnd but not a definate dx of pls/als
i go to mnd clinic next month and will have emg to find out.

[Geo]

How about MMN Multifocal Motor Neuropathy or CIDP Chronic Inflamitory Demilinating Polyneuropathy ,TSP Tropical Spastic Paraperesis Might look into these Geo

[olly]

i had a clean nvc and my neuro said it was not neuropathy, i'll just have to wait for mnd clinic and emg.:confused:

[MICHELLE40f]

every site that I have read,does say that PLS causes muscle weakness,not atrophy,but weakness yes.

[Geo]

NCV is Nerve Conduction Velocity LOL .How fast the signal gets from point a to point b Geo

[Geo]

Michelle try this . Squeeze someones hand as hard as you can .Do this once a month . This will show you if your losing strength . This person will know if they feel your not grabbing as hard . yes i can aggree somewhat on the kind of weakness when im bending over to sit on the toilet i have to grab the counter so i'll land ok on the toilet . Otherwise im afraid i'll land in the tub or fall back against the tank and break it LOL Geo

[Geo]

Olly ,Justr be brave ,i closed my eyes , i didnt want to see what was going to happen and yes i had tears
i wont lie . Connie said after watching. No More .But you want to know Geo

[olly]

yes, sorry geo i do know what ncv is ,wrong choice of word "clean" lol.
anyway it was ok. im not looking forward to emg, iv'e heard some bad stories.
but its better to know , one way or another.

[MICHELLE40f]

Olly,do not be afraid of the emg,I heard horrible stories,went in the doctors office a nervous wreck,the doc started the emg and i honestly didnt even feel him stick the first needle in!! One time in my neck it smarted a little,but thats about it,no big deal at all to me.

also wanted to ask if you have read any on the disease HSP? (hereditary spastic paraplegia) that is what my neurologist has diagnosed me with,the neuro that did my emg also mentioned PLS as an alternate diagnoses,you do not have to show a family pattern to have this as it can skip generations etc....go to the spastic paraplegia foundation website if you would like to read symptoms etc.of this disorder.

goodluck,Michelle:)

[MICHELLE40f]

geo.lol that test may not work too well on me,being that the weakness I have is mostly in the legs,but I know what you are saying,the neuro always checks that way,he agrees that most of my weakness thus far is in the legs. The reason for my earlier post is that some seem to be confused on rather PLS actually does have weakness as a symptom,and according to my neuro and every website i have been to on pls, muscle weakness is a symptom,unfortunately.

[olly]

iv'e no family history of hsp , also had genetic testing and everything ok,so in my case its sporadic.
the difference between hsp and pls is that in pls symptoms/signs are more progressive and in upper body and bulbar rather than just in legs/lower body as in hsp.

[MICHELLE40f]

olly,I have some slurred speech and some minor arm weakness,and "minor swallowing" problems at night..wake up feeling like i am choking on spit? i guess,anyway i told my neuro of this and he says that is part of my disease....so i get very confused about my diagnoses,although the spastic paraplegia website does say that some people get swallowing problems and slurred speech arm symptoms etc with it too?

rate of progression can also vary,some people with hsp have as fast a progression as with pls,others have very slow progression in either case,so it does get confusing.

[olly]

have you seen articles at emedicine
hsp------http://www.emedecine.com/pmr/topic45.htm
pls-------http://www.emedecine.com/neuro/topic324.htm
there is complicated hsp that can effect swallowing ect ,but its usually hereditory and not sporadic.
sporadic sp with upper body /bulbar symptoms is pls, though some neuro's get them mixed up but progression will destinguish which one.
if your not happy with your dx get a second opinion.
hope that helps a bit.
caroline

[olly]

In most forms of HSP, the condition primarily affects the lower body. However, rare forms of the disease can also have upper body or additional neurological symptoms. In PLS, the arms, speech and swallowing are generally affected as well. Symptoms typically start in the lower body, although they can begin in the upper body, first.

Predominant features
hsp
Insidious, progressive spasticity and weakness of the legs that often gets severe, requiring assistive devices. There is also difficulty with balance, clumsiness, and often muscle spasms.
pls
Progressive spasticity and weakness of the legs that often gets severe, requiring assistive devices. There may be muscle spasms. Weakness and spasticity in the arms and hands also occurs, as well as in the bulbar muscles, causing slurred speech and difficulty swallowing. Sometimes, symptoms begin in the upper body first.

Secondary features
hsp
Urinary urgency and frequency is common and high arched feet are often present. Very rare types can present speech problems, ataxia, mental retardation, dementia, visual or hearing dysfunctions, extrapyramidal dysfunctions, adrenal insufficiency, or ichthyosis. While the arms are not generally affected enough to produce symptoms, some patients report minor spasticity and weakness in the arms.
pls
None
from spf foundation

[MICHELLE40f]

yes i have read all of those sites on hsp/pls, tis why i get so confused when my neuro tells me all my symptoms are from "my disease" hsp seems i have symptoms that could be either hsp or pls....only thing is i have a very slow progression for pls,then again on the pls data base alot of people have slower progression,,,,,,,,ugh who knows? LOL :confused: thanks again

[Geo]

This is why we need our Doctors to be on top of things so they can differentiate between the different ones or know to run the necessary tests . When we have health care people that dont stay on top in their field the patient suffers .Just like in my ex profession we had people who just sat back and road the gravy train
Well the state finally stepped in and said we are going to have Continuing Education in all Licensed fields ,that means you must complete a field related class in order to renew your license every year .This means you will stay on top or you wont have a job .No more Gravy train Geo

[Geo]

Michelle when you say Choking on spit . This is due to the muscle in the orapharyngeal area and the neck and throat constrict or tighten and close in on eachother making them come together and touch . Look at your throat and neck as a pipe .If that pipe constricts on itself it makes it feel like your choking or gagging on spit .Clearing your throat alot will help some ,take a drink of water, just a little ,sleep on your side rather than on the back . On cold nights i use a heating pad under my back ,kind of relaxes the muscles . Hope this helps Geo

[MICHELLE40f]

thanks a lot geo! i never knew that about the choking!:mrgreen:

[Geo]

Your welcome . Have you ever noticed having problems swallowing your pills or swallowing large pieces of food .This is because those muscles i mentioned are constricted or tight . Takes alot of muscles to swallow
we dont realize this until we have a disease like ours lots of complex things going on . My big problem is cold liquids ,i learned to move everything to the left side and it goes down alot better Geo