Does this sound like ALS?

j100f

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Hi Everyone,

In August of 2023 I woke up with terrible leg pain in hamstrings by November the pain wasn't getting better. I saw a general nuerologist, had an emg which was normal he said its benign and not to worry. By December the pain started to subside ,but I started having weakness, tremors, muscle twitching and swallowing problems.

I then saw a nueromusclar specialist in January 2024 who sent me to an ent who diagnosed me with muscle tension dysphonia, the nueromusclar specialist did an emg, ran a ton of bloodwork, did some genetic testing and it all came back normal. I've been getting weaker in my arms and legs ever since, I have developed slight tremors in my hands and jaw since then. The nuerologist is going to do another emg in 2 weeks. I asked the nuerologist could this be als, she said she isn't sure, let's see what the emg shows. I haven't fallen, but I used to be very athletic could easily lift 20lbs weights, im now struggling with 10lbs weights, my arms and legs start to shake if I put any type of resistance on them and swallowing isn't normal, I can get food down, but swallowing saliva can be difficult, especially at night.This January would be 18 months since all this started, if my emg is normal at this point , could it still be als?

Thank you for listening
 
If your emg is normal and you don't have a clinical exam that demonstrates significant upper motor neuron findings then I would think als would be off the table and your neurologist would either pursue a different neurological diagnosis or refer you elsewhere - another specialty or back to your pcp
 
The nuerologist sent me to see a physical therapist who works at an als clinic and she said something is not right with my muscles in regards to endurance and strength, but this isn't a typical als presentation, she wants to see what the emg results are before she begins an exercise routine with me.
 
I had an EMG last week and just received the results, I pasted the impression below. Please let me know if you think I need to be concerned with ALS, my previous EMG in July was a normal study.

Interpretation/Conclusion: This is a minimally abnormal study.

The electrophysiological evaluation of the left upper and both lower limbs showed:
1)normal median, ulnar, tibial and peroneal motor evoked responses
2)normal median, ulnar and sural sensory nerve action potentials(SNAPs)
3)a few fasciculations in right tibialis anterior and both gastrocnemius
4) normal needle EMG with exception of decreased recruitment of large duration motor unit potentials right tibialis anteriorand gastrocnemius.
There is no electrodiagnostic evidence of a motor neuron disorder in this study.
Of note, it was significant activation of normal motor units and no abnormal spontaneous activity in mentalis muscle. The abnormal EMG findings could be seen in a chronic uncompensated radiculopathy.
 
No you don’t. As it says no evidence of mnd. You said they were waiting on emg results to decide about pt. This looks like a back issue so pt would be an obvious next step
 
The neurologist wrote no evidence of MND but the part where she states "decreased recruitment of large duration motor unit potentials right tibialis anteriorand gastrocnemius." I have weakness in my both arms and both legs, I also have tremors in my hands and jaw, I am going to start pt, but I know something is happening here with the weakness and tremors, they have run a ton of blood tests ,imaging and did genetic testing all with normal results. I will see the neurologist again next month, any suggestions on what type of condition I am dealing with tor additional tests/questions I should be asking.

Thanks
 
Those findings are not indicative of mnd which is why they wrote that And they noted the normal mentalis muscle because you reported jaw symptoms Re what conditions are remaining on the table - that is precisely what you should ask your doctor If you have all those symptoms and they were related to mnd your emg would look very different
 
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