Old 06-30-2008, 01:57 PM #31 (permalink)
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Default fibrillations?

during my studies of the cns i found out myelin sheaths surround peripheral nerves as well as in the cns.
ms is the demyelition of the myelin sheath in the greater white matter of the brain, vibration sensation is a common symptom.
smaller unmyelinated nerve fibres conduct impulses more slowly than the larger ones associated with demyelition in ms.
so could the vibration sensation we feel be something to do with abnormal impulses caused by damage to the nerve fibres in the peripheral nerves? and could this be related to fibrillations? would some peripheral nerves be classed as umn/lmn? .

also another thing. there are sensory nerves in the tongue. i have tingling and slight numbness and my tongue feels bigger,this gets worse as the day goes on after talking/eating etc.
as this is bulbar and is from damage to the brain stem would it show up on a emg/sensory that is? i have been told both umn and lmn shows on a emg in bulbar.
what would the sensory feelings indicate?
i also feel like the back of my tongue into my throat is straining,maybe spasms.
under my chin has felt sore deep inside also under my tongue.

wright........you are forgiven lol
take care
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Old 06-30-2008, 02:01 PM #32 (permalink)
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Hello Wright

Thanks for the correction but truth be told, you could have said the moon was made out of 'cheese' and depending on the type, I may have believed you!

I have an interesting muscle biopsy result. Would you mind if I pm'd you?

take care
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Old 06-30-2008, 03:12 PM #33 (permalink)
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Thank you for forgiving me, Caroline. Your are too kind.


so could the vibration sensation we feel be something to do with abnormal impulses caused by damage to the nerve fibres in the peripheral nerves?

Yes, that is definitely a possibility, which is what I had posted earlier in this thread


and could this be related to fibrillations?

No, it is not related to fibriliations. Again, fibrilations are due to the electrical activity in single muscle fibers and that electrical activity in those fibers is elicited by motor neurons and not sensory neurons. Furthermore, we cannot feel fibrillations.


would some peripheral nerves be classed as umn/lmn?

Peripheral nerves arise from lower motor neurons of the brainstem and spinal cord. Upper motor neurons are those that are contained in the cerebral cortex of the brain and do project to other neurons of the brain (including the brainstem) and spinal cord but remain in the central nervous system. Therefore, peripheral nerves ARE NOT classified as umn.


as this is bulbar and is from damage to the brain stem would it show up on a emg/sensory that is?

They would show-up on the EMG if the bulbar symptoms are being caused by the lower motor neurons of the brainstem. Bulbar symptoms can also arise from the upper motor neurons of the cerebral cortex (e.g. pseudobulbar palsy) and therefore would not show-up on the EMG. Again, upper motor neuron death cannot be detected by EMG. I am 100% confident of that, which is why again, those people with upper motor neuron onset ALS have clean EMG's initially and those with PLS have clean EMG's. The EMG's get "dirty" when and only when there is lower motor neuron death (i.e. from brainstem and spinal cord neurons). THAT IS NOT MY OPINION . . . THAT IS A FACT.


i have been told both umn and lmn shows on a emg in bulbar.

I'm not sure who told you that bulbar symptoms from upper motor neurons will show-up on an EMG, but they are WRONG. As I said above, the only time an EMG will be dirty with bulbar onset ALS is when the symptoms are due to the death of neurons from the brainstem.


Lovelily: you are more than welcome to PM me.
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Old 06-30-2008, 03:24 PM #34 (permalink)
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I have bulbar onset and my emgs were clean as well until I had arm and leg weakness.
So yes that is fact. Thats why my neuros were confused.

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Old 06-30-2008, 03:45 PM #35 (permalink)
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I'm still attempting to digest all of the latest that you wrote. ... A little off of the topic here, did you read the post started by me titled "response to the "weak voice" post/ thread" ? It is on this same forum. I posted a link to a a scholarly article I found last autumn, when the question of MG had been raised for me (and my first clue it might be ALS after reading it!) ... in it, the otolaryngologist (author of article) mentions "Palatal myoclonus causes rhythmic 1- to 2-Hz contractions of the soft palate, larynx, and pharynx" what the heck does she mean by 1-2 Hz. What is Hz, is it the electrical activity you were referring to? For those that have bulbar palsy, this is a discouraging assessment to read, so if you're not in the mood for it, don't. It doesn't have anything positive to say, but it is helpful is showing how the diseases with similar symptoms are differentiated...
(now going to go re-read what you just posted again)
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Old 06-30-2008, 03:53 PM #36 (permalink)
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Rose

Hz (which is an abbreviation for the word hertz . . . not the car company, by the way ) simply means: the times an event occurs per second.

In this case, if they are saying that spasms are occuring at 1 - 2 Hz, it simply means that the muscles are contracting/spasming 1 to 2 times per second.
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Old 06-30-2008, 04:16 PM #37 (permalink)
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Quote:
Originally Posted by wright View Post
Rose

Hz (which is an abbreviation for the word hertz . . . not the car company, by the way ) simply means: the times an event occurs per second.

In this case, if they are saying that spasms are occuring at 1 - 2 Hz, it simply means that the muscles are contracting/spasming 1 to 2 times per second.
So I guess Hertz (the car rental company) would have us to believe that we can rent one of their vehicles in a second or less, or that they will rent us super speedy cars LOL... Thanks for clarifying. I guess because megahertz and gigahertz are so often used when referring to electrically powered things that I'd thought it could have had something to do with our neurons firing... thanks very much
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Old 06-30-2008, 04:37 PM #38 (permalink)
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thankyou wright, a few people even someone with pls said umn bulbar symptoms showed up in a emg and this confused me.
i looked on some back dated posts about tongue fassic's and what they look like.
when i relax my tongue on the floor of the mouth,not sticking it out i have visable twitchings in it and either side of one site were they are worse in the middle my tongue is sunken and lumpy. even if i stick it out there is twitching but i read the neuro's observe it in a resting relaxed position. what is a scolloped tongue? is the outline of the tongue supposed to be evenly smooth and round? my tongue outline goes in and out slightly. i am getting very freaked out by all this and have decided to try and ignore the bulbar symptoms the best i can till the speech therapist comes.........easier said than done lol.
take care
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Old 06-30-2008, 06:40 PM #39 (permalink)
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Default Oily

Quote:
Originally Posted by olly View Post
thankyou wright, a few people even someone with pls said umn bulbar symptoms showed up in a emg and this confused me.
i looked on some back dated posts about tongue fassic's and what they look like.
when i relax my tongue on the floor of the mouth,not sticking it out i have visable twitchings in it and either side of one site were they are worse in the middle my tongue is sunken and lumpy. even if i stick it out there is twitching but i read the neuro's observe it in a resting relaxed position. what is a scolloped tongue? is the outline of the tongue supposed to be evenly smooth and round? my tongue outline goes in and out slightly. i am getting very freaked out by all this and have decided to try and ignore the bulbar symptoms the best i can till the speech therapist comes.........easier said than done lol.
take care
caroline
Caroline, you've been in my thoughts so much! Yes, I think it s a good idea to just chill untill your speech therapist comes. A word about this though...

The first time I saw a speech therapist was in October of last year. Then I was having no symptoms other than the extreme fatigue, the weak voice (and the chest stuff that just doesn't have anything to do with the speech therapist) .. anyway, I went for an evaluation, and she told me that my voice sounded nasal, and I was really actually offended by that. (I didn't tell her though) although, I guess I was even a little defensive with her, thinking back. Anyway, I'd always had what people considered to have a very pleasant voice. When I'd be working on the plane others on the crew would say that I should make the announcements because I sounded so nice (not the case anymore LOL) So, my point is to expect your therapist to point out problems that you're not aware that you have... fast forwarding to when I saw the speech pathologists, (for the modified swallow test) THEY also found more wrong with me than I knew. It's just one of those "shifts" where it went from me trying to explain what was wrong, but the professionals couldn't really detect it , to the shoe being on the other foot, so to speak, and the professionals telling me what was wrong that I wasn't able to tell.

The scalloped tongue, for me at least, is that the edge of the tongue all the way around my mouth is rippled at the edge, it is grooved out exactly to the shape of my teeth. the top is starting to have the imprint of the pattern of grooves in the roof of my mouth now too....

You hang in there, I know these next two weeks are going to probably crawl by for you, but that's life! (my doctor's office called to remind me of my appointment in a week's time down at Johns Hopkins, and I thought, like I was going to forget! How impossible would that be!
(hugs)
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Old 07-01-2008, 09:35 AM #40 (permalink)
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Default thought on vibration sensations

i was thinking about this last night and i thought if the vibration sensation was from abnormal impulses caused by damage to the peripheral nerves would that not show up on the ncv test?
as the ncv test is normal in mnd then this would not be the case.
i know alot of people with pls have this sensation. so could it be a umn symptom/related? perhaps it could be something to do with clonus?
next time i see my pt i will ask.
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Old 07-01-2008, 09:52 AM #41 (permalink)
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That's a good point Caroline, but the NCV has been shown to be abnormal in a small percentage of ALS patients, as are sensory symptoms (this "purring" sensation would certainly fall into the sensory symptom category).

You are absolutely correct, though: this "purring" could very well be due to upper motor neuron death/dysfunction, because people with MS feel it as well.

I'm hopeful that Rose will get some answers . . . or at least some speculation . . . from the neuro's at Hopkins.
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Old 07-01-2008, 10:20 AM #42 (permalink)
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Default wright

my ncv was normal and i had the vibration sensation at the time.
another question..............in pls you can have muscle twitching/fassics but no atrophy,could this be the same with the tongue? could the twitches in my tongue and swallowing be umn related? i am grasping at straws here.
take care
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Old 07-02-2008, 08:02 AM #43 (permalink)
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Default thankyou rose.

i am sorry about my manners,i was in such a state yesterday i forgot to thankyou for your encouraging last post. thankyou for thinking of me,i have been thinking of you also. i really hope things go ok at your appointment next week, as well as they can anyway. i feel better today and keep telling myself the bulbar symptoms are not that bad and i will be ok,though last night i had difficulty swallowing my meds and they got stuck in my throat so i had to drink lots of water to budge them,3 tiny tablets.
but i am doing ok and not as bad as others on the forum so i should not complain,it is just so lonely dealing with all this as i dont like to tell my son much or family.
i hope you are not feeling too unwell,i will keep you in my thoughts and prayers.
godbless
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