View Full Version : Upper and lower motor signs
fmarino
03-09-2008, 04:54 PM
I know there are variants to motor neuron diseases: for example, PLS (only upper motor neurons involved), PMA (only lower motor neurons involved) and ALS (both upper and lower motor neurons involved)
If you trully have ALS, do the upper and lower motor signs usually happen at the same time . . . are they present when you notice one of the signs or the other. That is, if you have weakness and atrophy (all lower motor signs) will you also have upper motor signs (brisk reflexes for example) when these symptoms show?
if you have umn only they wait 3-5yrs to see if lmn develops before a dx of pls
if you have lmn only it could be pma/sma or neuropathy etc.
in als there is usually always a mix present, though some may not develop umn till later on in the desease.
so it's a case of watch and see what happens in alot of us.
hope that helps.
fmarino
03-09-2008, 05:19 PM
That did help, Olly, thank you.
So how much longer does it take for UMN signs to show-up if the LMN signs are present? Is there an average time? But again, you said that they usually present at the same time . . . is that right?
yes in als it's both, but as i said iv'e read "sometimes" the umn signs can show up late.
Tall John
03-09-2008, 09:51 PM
my umn took a year and a half to show up after my lmn's.
Lorie
03-09-2008, 10:46 PM
I posted this link the other day. It may help to better understand the process.
http://www.disaboom.com/Health/lougehrigsdisease/Diagnosis.aspx
Lorie
If you have been diagnosed with ALS and your arm was the first weakness noticed 5 yrs ago, would it be normal to still have use in your arms? If it weren't for my arm strength I would not be able to get out of a chair relying on leg strength alone. I realize that I have weakness throughout my body, but I haven't lost use of any of my limbs. Would this be normal after nearly 5 yrs of noticing the first symptoms? Don't get me wrong, by no means am I complaining, I thank God each day, but I am just curious.
fmarino
03-10-2008, 01:50 AM
Is that common to have your UMN show-up so late? Olly seemed to say that they commonly happen at the same time.
Did you read my other thread? What do you think?
Thanks for taking the time.
fmarino
usually you would have weakness somewere or atrophy /lmn combined with umn like hypereflexia, it's not very ofton you would develop umn signs later.
jake
i too have general weakness, i have hip girdle/shoulder girdle limb weakness, some areas i have hypotonicity/flacid paralysis this is more profound in my left lower leg.
the weakness has progressed over 8yrs, but has got worse over past year.
Olly, Thanks for your reply, hopefully there will be others that have ALS that will give me their input on this situation too.
Tall John
03-10-2008, 08:10 PM
Hyperreflexia is not UMN. UMN would be spasicity, positive Babinsky etc. It is unusual, but not impossible, to have hyperreflexia and have it be MMN.
wright
03-10-2008, 08:21 PM
Hey TallJohn
Hyperreflexia (i.e. brisk reflexes) is UMN. Did you mean hyperreflexia is not LMN?
hyperreflexia/over active reflexexs is umn ,i think your getting mixed up with hyporeflexia/under active. in neuropathy reflexes can be underactive not over:!:
Peg B
03-11-2008, 11:54 AM
Hi,
I began symptoms in 2002, my right hand - finger curled and great difficulty just writing checks and sore when walking (but had arthritis) . At the time, I asked the neurologist if I had ALS or MS or some other systemic problem, she said No and I must have a pinched nerve. The second neuro said I needed to exercise and walk more - this was after I fell (went flying on black ice) off the porch and landed on the ground tailbone first. After many falls and my finger not being able to move at all, the third neuro Oct 31, 2006 - said "ALS," and sent me for a second opinion. He made it clear he was angry at the first two neuros.
ALS clinic said I tested positive for ALS on EMG/NCV study, for lower but no upper signs, so maybe MMN (multifocal motor neuropathy) and put me IVIG trial beginning January, 2007. Because I have not made significant improvement and may be a bit worse - legs, hand, tiredness. I will have a new EMG/NCV study on May 1 (changed form April 3). If it does not show improvement they will change the DX to ALS (atypical).
When I read about MMN, one of the things said, was it really could be ALS, but the upper neuron signs don't show up "until autopsy." So, for me, who knows for sure, and the "one day at a time," life style seems to be the best option.
I thought another scenario, might be helpful, but apologize if it just adds to the confusion over this. Best Wishes, Peg
untill they find out what causes mnd's a dx of any mnd is down to a emg,progression,guess work. on postmortem tests those with pls show signs of lmn involvment, with sma/pma upper involvment. eventually even when not evident during life the localized involvment spreads to the other . that is why they call them varients.
im ms there are varients,relapsing/remiting,chronic progressive.
sorry forgot to add umn signs don't show on emg,there is no test other than a mrs(like mri) that shows up umn signs. it's all down to neuro exam to test reflexes ect.
Peg B
03-11-2008, 05:43 PM
Hi Olly,
"ALS clinic said I tested positive for ALS on EMG/NCV study, for lower but no upper signs." I did not mean to imply that umn, did show on EMG. I have no clinical signs of umn.
For what it's worth, my first cousin has PLS, DX in 1993. He lives in CA and I have not seen him for about 40 years. He is unable to walk since last summer without one or even two canes. Peg
