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Edward E

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CALS
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My wife has had an upper motor neuron disease diagnosis about a year ago. She has also had reflexes categorized as hyperreflexia. She has clinical weakness that has continued to get worse. She has wasting especially the wrist and hands(between thumb and hand). Recently I noticed fasciculations in that area. My question is are fasics specifically lower motor neuron related? What would this mean for her progression etc? Thanks for any input.
Ed
 
Fasciculations are listed as LMN signs. I may be an odd case, but one of my first indications of ALS was fasiculations in my left arm. The muscles between the thumb and wrist form what is called the thenar eminence and that was among the first areas where I showed atrophy. Later I had lots of fasciculations in my legs, but thirty years of very, very slow progression later, guess which muscles are hanging in there? Yes, my left lower arm is the strongest of my extremities! My leg strength went first, and now my right arm doesn't have any functional ability -- but my left lower arm can still move enough to push a mouse around! I can't lift it but it is a big help in using the computer. I am not a typical ALS patient in terms of speed of progression, but the order of areas affected has been very typical. So as far as fasciculations being predictive, they weren't for me. This little bit of anecdotal evidence, is, like all anecdotal evidence, not proof, but maybe enough to hang a bit of hope on.
 
Edward,
Wasting/atrophy is more LMN-related. If/as the wasting progresses, another EMG to monitor for LMN damage might be helpful in establishing if your wife still should be considered PLS.

Best,
Laurie
 
In general fasiculations indicate LMN involvement. Having said that I have fasiculations on my calf, hands and arms and I've had Bulbar PLS (starts with speech) for 13 years. I asked my neuro about them and he seemed unconcerned. As far as I know I don't have any muscle wasting. I have not had any significant progression for the last 5 years and I still have them. A high percent of PLS'ers have non-typical PLS symptoms. You really need an EMG to rule LMN in or out.
 
In PLS only (UMN only) from the Primary Motor Cortex (top of your head) all the way down to your feet... there is no defective mechanism to cause them unlike that of ALS. Split Hand Syndrome, he wasting between the thumb and wrist, but more so between the thumb and index finger, has been batted around by Neurologists as an early sign of onset ALS. However... the has been no accredited evidence to support that observation. Some people can actually have Carpel Tunnel Syndrome without noticeable symptoms and that can attribute to some wasting in the hands.

Another one batted around is that in PLS only Baclofen will have a propensity to minimize non related fasciculation... "twitches". All in all, for now... don't worry about the fasciculation.
 
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I think they don't know very well. On the other forum (alstdi) there is a guy who has upper motor neuron disease and he has spasms and fasciculations, so who knows? and there are the ones who has benign fasciculations which according to doctors does not mean anything...
 
As we have noted, an EMG remains the gold standard for revealing LMN involvement, so there is really no point in trying to interpret fascics, which, as you have read from others here, do not necessarily differentiate.
 
Once again... In PLS only (UMN only) from the Primary Motor Cortex (top of your head) all the way down to your feet... there is no defective mechanism to cause them unlike that of ALS.

Having PLS does not exclude Anxiety.

As for the word "spasms"... Charlie Horses are part of PLS symptoms. And... there is a difference between Charlie Horses and Cramps. One involves muscles and the other involves tendons. Another form of spams (there's more than one of them) would indicate Parkinson's.
 
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