I peeked in & now I wish I hadnt! Upper/lower weakness?

[SilverLining]

Ok, so I made the mistake of peeking in today. I was reading someones question about upper and lower motor nueron weakness and am worried. But Im not going to get crazy. I just would like an explanation so i may understand this and once again, leave peacefully,

What if my toe weakness is due to an upper motor neuron weakness. How can I be sure if its weakness is due to upper or lower. If its an upper motor neuron weakness than the emg would not have shown anything (which is what happened). Now Im confused, :-(

I can barely move it, its weak, "clinically" weak. Dr said so. I cant lift it up. I can only "Slightly flex it down, slightly......."I have brisk knee reflexes.

I dont understand all this. Upper motor nueron weakness would show spastisity ect?

How can there be a distinction between weak? Weak is weak so what does weakness due to uper motor neuron weakness mean & now how do I know if the emg really ruled out als if I dont know which weakness I have? :-(

By the way, I thought of you all...........Hope you are holding up.

 

[Zaphoon]

My experience with upper motor neuron trouble has been spasticity (involuntary flexing or tightening of muscles), continual cramping and fasciculations, hyperreflexia, voice going hoarse, stiffness and weight loss.

The muscles have, at times, been so stiff that they have been difficult to move which has produced a weakness type of effect. The kind of true weakness that upper motor neuron death produces comes from a lack of upper motor neurons communicating with the lower motor neurons that innervate the muscles. When you have too few upper motor neurons to do the job, the full message cannot be relayed to the muscle. This is my understanding.

Hope this helps.

 

[wright]

I already explained this to you in the other thread that you started, that asked the same exact question. Do people on here simply not listen to a thing anyone says? I will copy and paste it here so you can read it again . . . or maybe for the first time . . . whatever the case might be. I have bolded it for you, too.

Here's the deal, SilverLining

The weakness you describe (i.e. the inability to move your toe) would be a "lower motor neuron" type weakness . . . and if your EMG was clean . . . that means it wasn't due to any type of lower motor neuron problem (especially not ALS) or to any neurological problem for that matter. It's as simple as that.

The EMG cannot detect upper motor neuron problems and upper motor neuron dysfunction can cause weakness . . . however . . . the weakness caused by upper motor neuron dysfunction would be due more to spasticity and stiffness AND there would be other upper motor neuron symptoms and signs present. These signs and symptoms would include very brisk reflexes, primitive reflexes (e.g. positive Babinski, Hoffman, etc.), etc. All of the upper motor neuron signs and symptoms are detected with a clinical exam and your clinical exam was fine.

What does all of this mean? You have no lower motor neuron problems and you have no upper motor neuron problems. What does that mean? That means that nothing about your story points toward ALS . . . not one thing. What does that mean? It means you really need to move away from these ALS thoughts. It isn't healthy and it isn't warranted in the least. Be done with this. I wish you peace.

 

[SilverLining]

Thx Zaphoon & Wright,

, I dont understand the weakness due to upper so I can only go by what you tell me. That my weakness would be a lower motor neuron type.

I guess its confusing. I read one thread it says Clean emg=no als, that als can pick up denerv? (spelling) before weakness but then I read people like halfin who had a clean emg then 2 months later a dirty? He is the only one I can think of offhand but Ive read more.

 

[trfogey]

how do I know if the emg really ruled out als if I dont know which weakness I have?

The EMG ruled out ALS for now because it ruled out lower motor neuron disease and you have to have both UMN and LMN involvement to qualify for a diagnosis of ALS. It did not, however, eliminate the possibility that you have PLS, which is the disease of the upper motor neurons that Zaphoon is describing. And -- before you ask -- a certain percentage of ALS patients are initially diagnosed with PLS, because their initial presentation of symptoms showed only upper motor neuron involvement -- meaning that they had clean EMGs. Later, they will develop lower motor neuron symptoms (with corresponding dirty EMGs), and their diagnosis is changed to ALS.

At this time, there is no medical instrument equivalent to the EMG that can detect UMN damage. That determination is made through a hands-on clinical examination. If you want to know whether you have symptoms of UMN damage, you'll need to ask your doctors.

Regardless of what is causing the current weakness in your toe, no one can ever guarantee that you won't develop ALS in the future. If your current weakness is caused by UMN problems, then I expect that your chances of developing ALS are much higher than average. If your current weakness is not caused by UMN damage, then your chances of developing ALS are probably no greater than the average person of your age, race, and ethnicity.

Now, you are faced with a decision. You have an unknown -- what's causing my toe weakness. You have a very improbable possible cause -- UMN damage due to PLS or UMN-dominant MND. You have literally hundreds of other possible causes -- some rare, some commonplace. Most of them treatable to some degree and a few, not.

Where are you going to focus your attention? Hopefully, you've learned your lesson about self-diagnosis from the Internet and you'll go back to your doctor if you have more questions, because he/she is the only one who has all the information necessary to know where you should go from here. If not, be prepared to go back to the same level of fear and frustration that you were feeling last week, because no website and no forum has the answer for you.

It's your choice. Consider your options well.

 

[SilverLining]

Hi TgFogey!

Yes, I completely understand what you are saying AND that is why I was asking if my weakness can be due to umn problems. I was trying to understand the difference between the two. Just want to know if my type of weakness is LMN type or UMN type & Wright seems confident that it would be a LMN type ...........I know nothing but would like to believe that the emg has ruled out als and I can only feel secure if I know this type of weakness would be LMN TYPE. Do i make sense?

ty! you are ALWAYS a great help!

 

[trfogey]

Remember when you were barking at me last week about calling your weak toe a stiff toe? There might have been a method to my madness.

I'm glad to hear that you are not all freaked out by this. I was afraid you might be.

See you around.

 

[SilverLining]

When you say a method to your madness, should I be analyzing stiff & weak?

When a person can not turn the key to the car ignition, is that weakness due to LMN or UMN? Is trigger finger LMN or UMN? How does one know?

You did make a VERY good point Trfogey, you said something about Limp & stiff. Would "LIMP" non moving finger or TOE (geazz, thats like a curse word around here) LOL be a LMN weakness whereas STIFF would be UMN weakness?

Geazzz, Im sooo confused!

 

[BarryG]

Ok stop trying to turn the ignition key with your toes and you will be fine!

 

[irismarie]

why give this person the chance to keep on tweaking and taking the piss for that is surely what is happening. ONly someone sick mentally would keep on like this.
I apologise in advance if that is not the case but if you took the time, dear visitor, to consider what most of us are going through, that some of our dear friends have died recently , then stop analyzing limp and stiff. Maybe you have sexual problems? If you are for real have some courage for the love of God and accept and get on with your life. But you could not be real

 

[olly]

hi silverlining.

i have had pls/umn disease for over a decade now,the symptoms zaphoon described are spot on.

if your weak toe was caused by umn disease i can safely say you would be in severe pain and very stiff at least in your legs.
you clearly dont have any umn symptoms/signs and with your clean emg that would rule out als.

i do have some hypotonia/lmn damage in my left leg that is clinically weak.
dont know how long or when it happened but one day i realised i can not move my 3middle toes..........however i do have disuse atrophy in that foot and ankle.

so,if its just a weak toe forget about it and stop torturing yourself as to what has caused it...........you may never know.
if you find you are crippled with pain and unable to move your legs or you are falling over alot..........in fact any major noticable decline in your body then you can begin to worry.
till then look after yourself and kids by getting any support or financial help you need.
i really hope things improve for you:smile:

 

[jspec]

Can this person please be banned? :?:

 

[handinhand]

Wow, what is going on here? I hardly go to this sight and this is why.... I want people to come here when they are troubled but, this is just over the top. Answer is given and that is all needed to be said. I think we should have a person, maybe trfogeyn can ck on these kinds of threads. More than three answers to the same question puts a red flag on that thread and no one respond? Could that work? Linda

 

[Moonmark]

Hi Silverlining,

I read your post about saying goodbye and thanks to everyone and then you come back only a few days letter and start obsessing all over again. You have asked your questions and received your answers. if you have new symptoms to report or ask about, maybe you should check in with the forum then.

In the meantime, I wonder if some medication for obsessive-compulsive disorder might help?

Sandra

 

[SilverLining]

Sorry to have upset you all, Honestly. Im just a worried mom. Sounds ridiculous but when you see your toe isnt functioning properly, it scary to think its a possibility of als. Never meant to upset you to the point of wanting to ban me. Its not necessary,
Thankyou all & God bless,

Kimberly

PS: ((SAndraD)) Not for nothing but OCD? Have you forgotten that you've been here for years with well over 30 posts? Seems theres a pot calling the kettle black.