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andirai

Active member
Joined
Jun 22, 2017
Messages
33
Reason
PALS
Diagnosis
08/2017
Country
US
State
Tennessee
City
Clarksville
Good afternoon,
I am one of a thousand people who visit the internet in search of answers that are not readily available from a neurologist. It is a frustrating process that drives us to chat rooms such as these seeking reassurance or answers and I am grateful for any input that is provided. So….

About a two years ago I started noticing small changes in my body, more specifically, my legs. I went bowling and each time I tried to throw the ball, I fell. I also fell a few times doing routine things and noticed that walking downstairs was very difficult.

I went to the doctor and they said I was overweight and needed to exercise. About a year ago I fell off my bike. I cannot even say what happened exactly, I was stopping and put my leg out and then I was just on the ground. I noticed that I could not run and sadly, I could no longer dance. I tell my legs to bounce to the rhythm and it just does not happen.

In October of 2016, after an examination of my walking and balance, my PCP sent me to a neurologist. The neurologist noted hyperreflexia and suggested I might have MS. An MRI of my spine and brain was conducted and there were no lesions present. The neurologist said an EMG could be performed but he did not think it would show anything. I was very frustrated because at this point I walked like Frankenstein if he were a toddler! I did not have insurance so I just suffered in silence.

In March of 2017 I became insured and started seeing a new neurologist. He performed an EMG on my legs that was positive for damage. He also noted the muscle weakness, hyperreflexia, clonus and spasticity in my legs. He ordered an MRI on my lumbar, cervical and thoracic spine. The results indicated some mild damage to my spinal cord but I am 48 so it is most likely age related. I also had a spinal tap that showed some of my muscle enzymes were up. I also have myelin basic protein in my spinal fluid indicating a breakdown of myelin in the nervous system. My SED rate was 25 so there is inflammation in my body somewhere.

He performed about $10,000 worth of blood work and it only showed that my thyroid was a bit low. I have had hypothyroidism for 20 years. He said that he checked for a lot of “nasty things” and all the tests were negative. I asked him if ALS was an option and he said it was “still on the table.” My family is happy every time a test comes back normal but I know that in order to diagnose ALS, everything else must be ruled out.

The muscle weakness is getting worse. I cannot just rise up out of a chair and have to use the handicap stall for help getting off the toilet. I go down the stairs on my butt because I am afraid of falling. I take Baclafen to help with the spasticity but it makes me so tired. I am frustrated and afraid. I am also seeking a second opinion from the Neurology center at Vanderbilt Hospital. The one thing I am thankful for is that I have NO PAIN…none, nada, zero. That also frightens me because ALS is primarily not a painful disease. If I were in pain, I would feel better about my situation actually. How odd.
 
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I am not sure if I posted something incorrectly but I have received no replies. Please I am desperate for some input. Thank you
 
If you could elaborate on the emg results it might help us comment. Some damage could mean changes that are most definitely not those of ALS, things that look like ALS , or nonspecific changes. Certainly your symptoms are worrying but if your emg was consistent with ALS you should have a diagnosis. A second opinion( with an ALS specialist) is an excellent idea
 
Please read the sticky titled 'read before posting'.

You failed to detail the results of your EMG, plz do so.
 
I was not being vague about the EMG, my neuro only said it was positive for nerve damage and I do not have the report on hand. I am concerned about UMN issues and I have weakness but no atrophy. I will resist commenting until I have a full EMG report. It is not my intention to waste anyone's time
 
I certainly understand your concern. Something is going on. I hope your second opinion is soon and they will explain better where you are in the diagnostic process- what is still on the table and what should be done to narrow things down. If you have not done so read the sticky on getting a diagnosis to prepare for your appointment. When you have your copy of the medical records reading everything and seeing test results in theit entirety may help you formulate some questions for your doctor please ask us if we can help you with this
 
Thank you for the response. Looking at the list provided, I can tell you that I have tested negative for:
Myasthenia gravis
Multiple sclerosis
Heavy metal poisoning
Medication reactions
Post viral syndrome
Lyme disease
Thyroid disease
Diabetic neuropathy
Vitamin deficiencies
Vitamin toxicities
Syphilis
HIV

I will try and get the EMG report today.
 
Ok, I have my EMG report, what should I be looking for?
 
The first thing to look at is the summary. Sometimes that is very clear and specific. What does it say? As well as the summary there are things to look at in the columns that might help understand but that gets complicated to explain

If you had an NCs too those findings are usually reported with the emg but if there is a separate summary for that see if it was normal and if not if you care to share it might help us comment
 
Ok, there is nothing that says "summary" but it does have a section marked "Impressions"

NCS/EMG of the right and left legs:
1. Bilateral saphenous neuropathies.
2. Left superficial peroneal neuropathy. There was no evidence of other focal compressive neuropathies or of a generalized peripheral neuropathy.
3. Needle EMG showed evidence of multilevel bilateral lumbosacral radiculopathies
 
You can almost rest assured you are not looking at ALS. Key word in your EMG impressions... lumbosacral. Being that the EMG was done on both legs and not a single side... legs and arms, the Neuro was probably suspect of a lumbar issue.

But... questions to consult with your Neuro. Maybe some of our more knowledgeable members may chime in.
 
Thank you so much! My hope is that my nerves in my spine are compressed but I have no pain. I appreciate the input.
 
A quick update. After another MRI, there is no spinal compression evident so a muscle biopsy was ordered. The result is denervation atrophy in my upper left bicep. I am now officially worried. My next appointment with neuro is Wednesday.
 
Abnormalities in sed rate and spinal fluid, coupled with the absence of atrophy after 2y of symptoms, suggest the possibility of an inflammatory myopathy, which I assume is one of the reasons for the muscle biopsy. Neuropathy can sometimes mask myopathy on an EMG.

ALS is of course a neuropathy and not a myopathy.
 
My neurologist confirmed that I do have a neuropathy. My muscle biopsy did not show any inflammation but my SED rate is elevated so there is inflammation somewhere. My neurologist used the terms ALS, Muscular Distrophy and CIDP (Chronic Inflammatory Demyelinating Polyneuropathy). I am going to get a second opinion and hope for something more concrete. My neuro did not schedule a follow up, treatment or additional testing...he wants to wait and see....I have waited long enough.
 
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