Difficulty with speech

[sya15]

My question.
My boyfriend 42 yrs old has had difficulty with speech x 10 mnths. Dx as spastic dysarthria. He has had 2 EMG which were normal. All reflexes normal. neg babinski. 5/5 muscle strength. balance/coordination WNL No other signs of UMN. No LMN involvement. Could it still be ALS? No difficultyswalling. speech has remained the same it hasn't gotten worse. If not ALS then what other diagnosed?

 

[trfogey]

Re: Help!

My question.
My boyfriend 42 yrs old has had difficulty with speech x 10 mnths. ALS diagnosis as spastic dysarthria. He has had 2 EMG which were normal. All reflexes normal. neg babinski. 5/5 muscle strength. balance/coordination WNL No other signs of UMN. No LMN involvement. Could it still be ALS? No difficultyswalling. speech has remained the same it hasn't gotten worse. If not ALS then what other ALS diagnosis?

Anything that can cause damage to the correct part of the brain can cause this condition. Strokes, head trauma, various types of infections, and various neurological diseases can potentially cause it.

I would suggest getting a clarification of the diagnosis and an explanation of the reasons behind it from the neurologist who has been taking care of your boyfriend. From what you've written here, it is difficult to figure out what he has, so it's impossible to comment further.

Good luck to both of you.

 

[alex scared]

Re: Help!

hi can firstly i say that it is awful that such a young fella and you have to deal with this situation. the immediate point that that leaps off the screen from your post is that your boyfriend has had 2 emg examinations . (i assume that these were carried out on the areas that were affected by your boyfriends symptoms ? ? Well if both of these came back without abnormalities then (and someone will correct me if i am wrong ) als is almost certainly eliminated . .i too have speech issues but a normal emg result so although i am far from am expert i can offer an opinion of substance the listof possible reasons for your boyfriends symptoms is long. Als should not be your first worry either way i wish you good luck and god bles . .Alex

 

[HelenL]

Re: Help!

A friend of mine has a condition called Spasmodic Dysphonia, for which she needs to get botox shots every few months or so. If she doesn't get these shots, she loses her voice, and just after the shot, her voice is a whisper.

 

[sya15]

Re: Help!

Thanks for everyones advice. I really appreciate it! I'm still confused about what could cause isolated speech problems.

 

[sya15]

Re: Help!

Hi again.
First I want to thank everyone for the feedback that I have recieved so far. I'm still confused and would appreciate further insight. My boyfriend is 42 and has had a speech impairment for 10 months. he saw one neurologist in Ct that did EMG which was normal. called his symptoms pseudobulbar palsy. I am a physical therapist and have been testing my boyfriend's strength,reflexes, balance/coordination. everything normal. I sent him to a neurologist in Boston who specializes in ALS . she did another EMG 4months ltr. which was normal. all reflexes WNL, strength5/5, coordination WNL. just isolated to speech which has not progressed. His speech is not slurred just slow effortful, nasal tone at times. MRI was neg for CVA, MS, it was normal. She ALS diagnosis as spastic dysarthria of unknown origin. She is not able to give a ALS diagnosis at this time. However still says its UMN. I'm still worried that it is ALS. Does any one know anybody who has started off like this and ended up with ALS?

 

[trfogey]

Re: Help!

Hi again.
First I want to thank everyone for the feedback that I have recieved so far. I'm still confused and would appreciate further insight. My boyfriend is 42 and has had a speech impairment for 10 months. he saw one neurologist in Ct that did EMG which was normal. called his symptoms pseudobulbar palsy. I am a physical therapist and have been testing my boyfriend's strength,reflexes, balance/coordination. everything normal. I sent him to a neurologist in Boston who specializes in ALS . she did another EMG 4months ltr. which was normal. all reflexes WNL, strength5/5, coordination WNL. just isolated to speech which has not progressed. His speech is not slurred just slow effortful, nasal tone at times. MRI was neg for CVA, MS, it was normal. She ALS diagnosis as spastic dysarthria of unknown origin. She is not able to give a ALS diagnosis at this time. However still says its UMN. I'm still worried that it is ALS. Does any one know anybody who has started off like this and ended up with ALS?

What do you want to hear? Are there patients out there who started off with bulbar upper motor neuron symptoms that later became full-blown ALS? I'm sure there probably are. There are probably also some folks that started out with PBP and did not progress to full-blown ALS. Only time will tell, unless another cause can be turned up to account for the symptoms he's experiencing.

Not very reassuring, I know, but sometimes that's the way things work out. There simply is no definitive test to say "ALS"/"not ALS." The two of you are now in "wait-and-see" territory, so that's what you'll have to do.

One other thing: we're kind of informal around here and not everyone is up to speed on the abbreviations you're tossing into your posts, so it would make your posts easier to understand if you would avoid using that stuff here. Thanks.

 

[munecagirl22]

Re: Help!

wow i have been reading thru post after post, i do not have a DX of ALS, or of anything yet, its pretty scarey scarey stuff, but it is werid that everyone and all post i read on here and other things NO ABNORMAL emg NO als, that is just so contridicting, its not even funny and the ALS clinic said so wow, let us all know how that turns out, i guess nothing has to be textbook at all.

 

[sya15]

Re: Help!

I will let you know. My boyfriend is seeing one of the best neurologist. She is head of the neurodepartment at mass general in boston. Only sees pt's with diagnosed of ALS or 2nd opinion. She has not ruled out ALS even with normal EMG however she stated can't rule it in either. She did more blood work to test for a few rare genetic UMN diseases get results in 3wks. Follow up EMG in 6 mnths. I guess its awaiting game. Thanks for your post. What is your story? what symptoms do you have?

 

[epkennedy]

Re: Help!

My pals sees same neurologist. She is the best of the best, no doubt. Good luck.

 

[notme]

I'd try to look at it as a good sign, hon. Perhaps even if it is ALS, it's slow progressing as all the symptoms are UMN at this time.

Limbo land sucks, I know. It's good that all his neuro testing otherwise is normal. Try to think of that as a glass half-full, not half-empty.

Is it possible he's having laryngeal spasms? Have they done the test where they stick the tube down and actually look? (Can't remember what it's called for some reason)

Or has he seen an ENT to be sure it's not something non-neurological in nature?

Muniegirl: LMN symptoms show up on an EMG. UMN symptoms do not. Those with ALL UMN symptoms are usually ultimately diagnosed with PLS (after YEARS) or HSP or other assorted disorders. And before you ask--UMN signs are SEEN EASILY BY A DOCTOR on clinical exam. So, please, don't post over on the Do I Have part with new symptoms!

 

[sya15]

Re: Help!

Thanks that is what I hear that she is the best. I can tell you so far I am very happy with her. She is so nice and caring!

 

[sya15]

I'm sorry if I'm repeating this. I tried to send a reply to you yesterday not sure if you recieved it. Thanks for your kind words. I know its a waiting game. I'm trying to be positive. Like I said his speech has remained the same and it is not slurred. Just effortful. Just being positive and enjoying life with him. I drive him crazy though constantly testing him and checking for signs. I need to stop! Sometimes I wish I didn't have the knowledge I do. I have worked with a lot of stroke, ms TBI pts. Only one ALS(in end stages) and one spinal cord. I do believe a positive outlook can heal. my thoughts and prayers are with you too! Oh I researched stem cell treatment however conflicting reports!