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dbltree

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I'm kind of a curious, research oriented kind of guy so there always things I wonder about? I searched this forum site repeatedly to attempt to see where my symptoms fit in, recognizing that there is often no "normal" when it comes to ALS.

I found the following description of upper and lower motor neurons helpful in part because when all of the tests were done...I had no idea what they were doing?

The classical signs of UMN lesions are usually stated as: weakness, increased tendon reflexes, spasticity and an extensor plantar response.[8] However, when there is additional neurogenic weakness due to LMN lesion in the same limb the tendon reflexes are often not clearly increased, spasticity cannot be demonstrated, supposedly because of the LMN weakness and the plantar response may be difficult to elicit, a difficulty often ascribed to differential weakness in toe and ankle flexor and extensor muscles. The plantar response is extensor in only some 50% of patients with ALS.[9]

The typical signs of LMN lesions are: weakness, muscle wasting, fasciculation, reduced tone and absent or reduced tendon reflexes
I share that because in my case LMN signs are clearly present but UMN are not that obvious(now that I know what they were doing!)

That said...my right hand/arm has profound weakness and atrophy and this is where it started about 10 months ago. My left arm/hand has very little weakness but atrophy is worse the right side?

Legs have no atrophy, weakness is in right leg/ankle but I do not have a drop foot?

Having read all the comments that weakness comes first and atrophy much later...I'm just curious? I am on the Deanna Protocol and again am curious as how it is affecting progression (since we are all different...nearly impossible to say?)

I also exercise and my exercise regime has been steady with no loss of ability to do any exercises over past 3 months.

How common is it to have atrophy before weakness?

How can my left arm have so much atrophy yet functionally still be the same?

My right leg has weakness and has had for 6 months yet it has no atrophy?

Just things I'm curious about...
 

mbmurray

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@dbltree, I have asked the same questions to myself...

You and I are very similar... I have definite LMN symptoms (fasciculations, atrophy) , but UMN not as much (no babinski or hoffman, but drs say my leg reflexes are brisk)

My right arm has atrophied especially the bicep and shoulder area, lesser extent the forearm and hand, but I do have full dexterity. I didn't notice weakness in my right arm until the atrophy was visible. The atrophy started almost 1.5 years ago, but I am still able to use my arm just not lift "heavy" things, no wrist drop.

My left arm I am just noticing some weakness/fatigue but no "apparent" atrophy.

As for both legs, no noticeable atrophy, but right leg is slightly weaker, but no foot drop.

My weight has been in the same range for past 5 years until today (205-215lbs)
 

dbltree

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Thanks MB...I watched some you tube videos of what deep tendon reflexes should look like and mine are not even remotely like that? No babinski either?

I only know what I read but...the more I read the more questions I have?
 

Nighthawk

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My experience with this disease is: wherever I have seen atrophy in my body (be it arms, hands, tights, legs, feet) I always experienced weakness first, as the vey first symptom.

Although, like you guys, I am somewhat confused because even when I have clear LMN signs (left hand atrophy, left arm atrophy, left tight atrophy, left foot atrophy, left leg atrophy and also fasciculations in the non-atrophied limbs) I still have VERY BRISK reflexes in both legs (I mean it, very, very brisk), I also have a very sensitive Ankle Clonus that triggers very easily, especially when on anxiety(both ankles, right and left). All of this is obviously UMN damage signs but, if I already have atrophy (which by itself is a clear sign of LMN damage) why aren't my reflexes decreased and however, are still so brisk?

All this puzzles me.


NH
 

Barbie

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This is a subject that has always confused me the most--so complex!

my husband has what appears to be all LMN in his arms and both L and U in his legs. in the beginning, it was mostly in his left arm but moved quickly to the right, his legs were mostly all UMN problems until the last year. His spasticity has decrease in his legs and atrophy has increased. clonus is still strong, facs are weaker. Babinski when diagnosed, not apparent anymore. reflexes still brisk, but less so.

NH I am puzzled too...
 

Cricket

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Just shows how we are all different. I had LMN, weakness then atrophy but sometimes the opposite. For me, weakness and atrophy was symmetrical and happening at the same time on both sides (feet, hands, legs and arms).

Like you dbltree, i was surprised at some of the stuff i could still do despite atrophy. I think it has to do with other muscles compensating and perhaps core strength (in my case at least). Since my core is weakening, i am noticing a decline.

Only now, 2yrs later am I showing some UMN signs (reflexes but no spasticity). Hmm! Interesting thread indeed :)
 

dbltree

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Interesting also that there seems to be both symmetrical and asymmetrical progression with no "this is common"?
 

Barbie

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I think symmetry can be a personal point of view. Not like, one are is fine and one not. I say my husband started in one arm--but that arm was just worst--the other limbs were already affected. there was not a big time gap. the neurons were just affected faster in that arm?
 

Bad Balance

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Have you asked your doctor these questions?
 

dbltree

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Spasticity is a feature of altered skeletal muscle performance in muscle tone involving hypertonia; it is also referred to as an unusual "tightness", stiffness, and/or "pull" of muscles. The word spasm comes from the Greek word σπασμός (spasmos), meaning "drawing, pulling."
I know many are taking meds for this but for those that are not...is it normal for spasticity to go away? I exercise and stretch but I noticed lately that "tightness" is not there now? I just assumed it would get worse?

Exercise does help with spasticity but until now it's always been there before working out, especially in the a.m....kinda weird but this is a "learn as I go" deal...:wink:
 

ECpara

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My husband has significant atrophy in his right leg (he calls it his "skinny leg"), but has no diminished mobility. His upper arms are also atrophied to a large extent but he can still swing a golf club. Go figure.
 

jpsteeler99

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I must have some atrophy in my legs cause I have no balance whatsoever. I am not sure it is weakness because I can lean against the kitchen counter for a long time without my legs getting tired. My left arm/hand has lost dexterity but I can still drive with it and lift fairly heavy objects. I can't pick up a penny off the counter though. My reflexes are as brisk as they can be and legs are very spastic. Any drug that I take to reduce spasticity makes my legs worse and very unbalanced.
 

pearshoot

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neur 1 in dec/09 said i suspect als neur 3 in feb/10 said sorry you have als. i still swing a golf club, but ball only goes abnout 75 yards max but still a grest game
 

jpier

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incredible indeed, very interesting info but comfusing for me,
 
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