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Suzannah

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Hi all,

I have read this board everyday for four years, and there is something I'm still unclear on. I was hoping someone might be able to explain it to me here (for those of you who don't know me, I usually post on the PLS board. I have a UMN diagnosis of hereditary spastic paraplegia that may or may not be true)

As my title suggests, I'm not clear how UMN and LMN symptoms exist simultaneously. For instance, if someone has UMN related spasticity, will that symptom eventually be "overwritten" (for lack of a better term) by later LMN damage or by the dying of of the UMN? Or are some limbs affected one way and the others another way? I'm not quite sure how to word what I'm trying to ask.

So I guess I should ask my real question, which is this. I was diagnosed due to extremely high tone in my legs and global hyperreflexes. In the last year or so, my hand started to atrophy between my thumb and first finger and on the inside of my thumb. My grip strength is very poor and now my hand has started twitching in those muscles. I've read enough here to know that is worrisome. Fairly recently, the tone in my legs had started to decrease somewhat. I'm unclear as to whether a decrease in spasticy is yay a good thing that points away from a mnd or a bad thing that points towards.

I do have a research appt follow-up on Thurs for a mnd study, so I'll be able to discuss with the doc then. But I was hoping someone could shed some light on the meantime. (And mods, feel free to move this post of needed, but I didn't feel it was exactly a dihals type post)

Sincerely,
Suzannah
 

Kristina1

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I'm newly diagnosed so definitely NOT one of the experts. I do know in myself I have both UPN and LMN signs coexisting in the same areas-- eg my hand has weakness and atrophy (LMN), fasiculations (LMN), hypereflexia/hoffman sign (UMN), and stiffness (UMN). What confuses is me is how the hyperrelfexia can continue once muscles in an affected area completely atrophy. If you can no longer move your legs and the muscles have atrophied, how would the leg be able to jump up when bumped with reflex hammer?

I asked my neurologist at the ALS clinic if my hyperrelfexes will subside over time because my over active gag reflex causes me a lot of trouble. But she said no, that if anything it may get even worse. I'm still not clear on that-- I feel like as the muscles weaken surely they could not mount a strong reflex jump, but I am not a doctor and am obviously missing something.
 

lgelb

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We are talking about two types of neurons, so if both types are damaged, there you have both UMN and LMN damage. The upper motor neurons originate in the brain and talk to the LMNs. The LMNs in the spinal column talk to the muscles and are responsible for voluntary movement. So without the LMNs you have paralysis. Without UMNs, the muscles still work but the brain isn't controlling them as well. So you have involuntary movement like stiffness and spasticity, as well as certain patterns of weakness. It is worth noting that some LMNs (the gammas) have to do with sensing/adjusting to position, so loss of balance isn't necessarily only due to weakness.
 

Lkaibel

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Kristina, our Doctor the big ALS Certified Clinic Director said that you can have hypo reflexes eventually in ALS as the muscles get weaker, in direct conflict with what your Doctor said. I have to love the absolute wealth of knowledge available on this disease - not that I am being sarcastic or anything :-/
 

Kristina1

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Lenore, huh wow! I have my 2nd opinion appointment coming up at the other major ALS clinic in my area, so I will be asking that doctor now too.
 

WendyWooG

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I had a mildly brisk reflex in one area only, my reflexes in my worst affected areas tend to go missing. This drives my neurologist nuts.

Although my diagnosis is ALS it is LMN dominant. My UMN symptoms are very mild and took 18 months to show up in clinical exam which lead the doctors to consider MMN.

There seems to be a huge difference of the balance to which any individual is affected as far as UMN and LMN symptoms are concerned.

Wendy
 

affected

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Once there is no impulse getting through to enough muscles in a limb to cause it to be paralysed completely there won't be any reflexes anymore.

Laurie gave the key in her response here. Think about it this way - UMN causes spasticity and hyperreflexes. These neurones run from the brain to the spinal cord. The LMN run from the spinal cord to the muscles. So when those LMN are destroyed and there is no impulse to cause the muscles to move the reflexes will be gone too. Oddly they can become increasingly hyper as deterioration happens and then can quite suddenly cease.

However spasticity is a bit different as it usually remains, but remember a huge thing about ALS is that every PALS is different, there are no rules this disease follows.

My Chris was UMN dominant and so he had a lot of spasticity and even when muscles wasted right away the tone remained high and this caused his shoulders to freeze and his hands to curls into tight claws. I did a lot of ROM and massage to help as much as possible but even once he could not use them a lot of tension remained.

Mike's Chrissy was LMN dominant and you often hear him talking about muscles becoming limp. My Chris never had limp muscles, he had tight muscles and the more they wasted (LMN cause) the tighter they became.

Hope that helps.
 

Suzannah

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Thanks all, for the info.

Affected - I think that's exactly what's been tripping me up - I keep seeing references to limp muscles, and I didn't know if that is a place that everyone ends up at, or if it is different for everyone. That makes sense to me about your husband's experience versus Mike's wife's experience.

Thanks!
--Suzannah
 

KimT

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Way before my diagnosis I had brisk reflexes everywhere except my left ankle. That had NO reflex. It still has no reflex even though I can still walk. I had very little gag reflex but now it seems a little more. Go figure.
 

Suzannah

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I have my appointment with the research doc tomorrow morning at 8:30am. I have to get up early and make a 90-120 min drive through rush hour traffic to another city. I will be curious as to what she has to say. Curious and nervous.
 
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