Bulldog, with PLS muscles that are over exerted will quiver, tremble, shake or other descriptive vocabulary. As the muscles continue to get a weaker signal... what's still there in mass will tremble, shake, whatever just going down a flight of stairs or trying to carry something with your arms/legs in proportion to what degree of muscle loss you have. Not atrophy (big difference). As PLS progresses it's really important not to give into it, as my Neuro told me with a little different twist of the common "Use it or lose it" phrase. His is, "Use it or lose it... sooner. But... don't over do it." Some may disagree but... work out exercise will not strengthen the failing signal from the Primary Motor Cortex. My saying is... "Use it but save it too."
Early clonus needs some form of significant trigger. Later, more so with ALS, a cool breeze on the face can trigger it. I'd say, my opinion, if you can still get around with a cane, climb stairs, descend stairs, get in and out of chair without having to scootch out to the end of it and struggle to get up right... it would take a wack on one of the reflex points to present clonus. But... the lack of brisk reflex doesn't rule out PLS either.
(Here's one for conversation... a lack of reflexes can also present itself in PLS and ALS. So, a brisk reflex is not a single indicator of PLS. That "brisk reflex" thing is not a chiseled in stone. Like the Babinski test... most people the toes come up and spread and with some folks the foot just doesn't move.) With the Hoffman test not every flick on the end of your "show 'em what you think" finger
will cause your thumb to flex in.
Here goes... for the most part Charlie Horses are muscles, cramps are tendons, fasciculation ("twitches") are muscle, clonus is tendons but some over the counter ointments say they relieve muscle cramps. ?? Is a tendon a muscle?
I guess it's why Neurologists get paid the big bucks. I sure ain't one either so talk with your Neuro.
