Old 06-17-2018, 10:36 AM #1 (permalink)
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Default LMND question

Hi, I apologize for starting a new thread. I had a thread in February but it has been closed.
My old thread was “flaccid in a week”. Sounds ridiculous but my muscle do go soft very rapidly.

I have been to 3 nuero and a rheumatologist since my last thread. They all agree something is going on but no def answers. They almost seem confused.

The neuros including an als specialist kept saying upper neurons look good. And they are the precious ones?

My question is basic. I understand als starts in one specific spot. And upper neurons control your movements.

1. Does LMND start in one spot? Or does LMND start body wide. I search everywhere and can’t find info.
2. Do lower motor neurons control your movements or just the muscle tension?

I can trigger my muscles but they are weaker and softer. All my joints are cracking due to the soft muscle tissue. This is not in my head, the drs. Noted the symptoms.

But they are not giving me specifics. I have a 3rd emg and more blood work in 2 weeks.

I know I need to trust my drs. But wanted to see if anyone had anything similar. The rheumatologist said what are you doing here, go to a nuero, the neuro said try a rheumatologist.
Thanks!
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Old 06-17-2018, 10:50 AM #2 (permalink)
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Default Re: LMND question

LMND does indeed start in one spot and spread from there. I expect the doctor was commenting on your umns because those signs are mostly what is found on your clinical exam.

LMN disease is seen on EMG and clinical weakness is the main thing that would be LMN on exam. Absolutely movement is impacted by LMND. The LMNs send signals to the muscles to make them work. Interrupted signal from the LMN means the muscle fails. More motor neuron failure more muscles. No matter how hard I tell my leg to do certain things it doesn’t move. That is how LMND in ALS shows itself

What did your first two emgs show? Did they say you had clinical weakness?

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Old 06-17-2018, 11:11 AM #3 (permalink)
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Default Re: LMND question

Hi, thank you for your quick response.
The first 2 emg showed slight issues but they said it could be a pinched nerve in my spine. They sent me for an mri of my spine. It showed some minor bulging in 2 spots but they said it looked normal.
So that’s why they requested another emg.

Thanks for your clear answer. The drs. Are great but two were foreign so there was a slight language barrier.

Thank you and I will report back after the emg.

If anything this has changed my life for the better if everything is ok. I have been more positive and realized how small other problems are that are not health related. I already did an als walk and donated.
Thank you for your time.
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Old 06-17-2018, 11:16 AM #4 (permalink)
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Default Re: LMND question

Just to illustrate what Nikki said, attached is a diagram of how muscle movement works associated with UMNs and LMNs.

I believe that by saying "UMNs are fine" your doctor was referring to the ALS diagnosis criteria, you need to have signs of UMN degeneration on clinical examination and LMN signs, clinically or electrophysiologically in multiple body areas. Pure LMN signs would give you a diagnosis of Progressive Muscular Atrophy, pure UMN, Primary Lateral Sclerosis. Both in the spectrum of ALS, but with different progressions.

The rheumatoid factors in your blood are all ok?
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Old 06-17-2018, 11:39 AM #5 (permalink)
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Default Re: LMND question

Hi, thank you. From looking online that was kinda what I was asking- does pma start in one spot like als or body wide. Nikki kindly answered, even though I may have phrased it wrong.

My rheumatoid factor was border line so I am assuming that why they want blood work for the 3rd time.

Thank you!
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Old 06-17-2018, 12:01 PM #6 (permalink)
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Default Re: LMND question

As Nikki says PMA starts in one spot and spreads, just like ALS. It is basically just a pure lower motor neuron form of ALS. EMG would show same characteristic abnormalities in PMA as it would for ALS.

Borderline, or low-titer rheumatoid factors are meaningless, especially in the absence of swollen joints..
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