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taratune

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My brother was seen at the ALS clinic last week and they decided that they needed to do more blood tests and to do another EMG. The new EMG is scheduled for tomorrow. He seems to be loosing muscle quickly. In May his Respiratory function was 107% of expected. Last week it was down to 81 % of expected. In May he had full function of his arms. Now he can not raise them above his head....only to shoulder level. In May he walked with a cane. Now he can barely walk with a heavy duty walker. He can not stand up from a sitting position without help. Is this a quick rate of decline?.....or I am just naive.

One of the muscle disease doctors who saw him suggested that he has some "cortico-spinal tract pathology".....because he has reflexes in a muscle that is quite weak.

Does anyone know what this means?

Thanks so much for any help in understanding what is happening.
Tara:confused:
 

wright

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Sorry to hear about your brother, Tara

You had actually posed that question in another one of your threads and I answered it, but maybe you missed it. I have simply copied and pasted it here.

Corticospinal tract pathology is another way of saying upper motor neuron dysfunction/death. Cortico (neurons of the cerebral cortex, which are the upper motor neurons) and spinal (neurons of the spinal cord, which are the lower motor neurons) and tract (another word for nerves). If the upper motor neurons are damaged or dead, their tracts that lead to the lower motor neurons are then damaged and causes the upper motor neuron symptoms (e.g. brisk reflexes, Babinski, Hoffman, spasticity).

You state that the neuro said his reflexes are diminished in his arm. That is not a sign of corticospinal tract pathology. As I said above, corticospinal tract pathology would cause brisk reflexes.

A diminished reflex is a sign of lower motor neuron dysfunction. If your brother has diminished reflexes, he doesn't have ALS. There is another MND with diminished reflexes called progressive muscular atrophy (PMA) that progresses slower than ALS. Chronic inflammatory demyelinating polyneuropathy (CIDP) is something else that presents with diminished reflexes and is treatable. Peripheral neuropathies also present with diminished reflexes.
 

olly

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i just thought i'd point out that tara said her brother "had reflexes in a muscle that was weak".
that would indicate umn+lmn involvement in that limb.
take care.
caroline
 

wright

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Oops, I thought it read "diminished reflexes" Thank you for pointing that out, Caroline and keeping me on my toes. :)
 

olly

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wright

thats ok:lol:,i knew that you had just read it wrong.
take good care.
caroline:-D
 

taratune

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Thank You,...... so much for helping to clarify things for me.

Today my brother had his EMG repeated at the ALS clinic. I did not get any report that included numbers but I did overhear the doctors talking about 3's and 4's. All they said was that he had evidence of motor neuron disease in all of the muscles they tested......which included his back, legs, arms and tongue. Apparently the tongue score was the best.....he just had one large ________ (I can't remember what the large thing was called). The doctor said something about evidence of chronic inflamation enervation renervation currently and also older nerve problems also.

We did not get any results from any of the blood work they did last week. One of the things that puzzles me is that he was walking with a cane only 2 months ago and now can barely walk with a big 4 wheeled walker and both of his arms/shoulders are getting pretty weak to.

I thought that the arm involvement would happen later and be more on the side where the leg weakness started first. Both of his arms appear to be equally weak. Whereas his left leg is much weaker than his right leg.

I will get a copy of the EMG report at some point. Will this test alone help to differentiate between the different motor neuron diseases? I read that PMA was Lower Motor Neurons only but since the cortico-spinal thing is Upper Motor Neuron symptom then.... that would make the diagnosed ALS.....right? Or is there still another possibility?

Thanks again for all the help you all so freely give. This forum is a true God send.

Tara
 
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