Is this recognisable?

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DidiB

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Hello everyone,



My problem started about a year ago. During walking, my right leg and foot were dragging because I felt that I could not generate enough force in my right calf. Also being seated I could not generate a contraction in my right calf similar to the left. I am a physiotherapist and felt that something was not right and was difficult to explain since I had never had any pain anywhere. Also no history of low back pain or other neurological issues. I visited a doctor in Physical Medicine who understood my concern. He did an EMG that came back negative and also did an MR of the vertebral column which showed a disc bulge L5-S1. To him, this could not be the cause of my complaint. His opinion was also confirmed by a neurosurgeon I know, who took a look at my scan. So, he sent me to a neurologist. She confirmed that I had less control in my right calf. Further neurological examination was normal, so she reassured me and suggested I wait and see.


In the months that followed, the symptoms continued to increase very slowly. This despite doing an exercice program. Walking distances became more difficult and gait became unstable at times when turning because the calf did not generate enough force. Others do not see that something is wrong, because I have not yet received any concerned comments. Since January I also began to have difficulties with my right hand. Writing and typing are often difficult and in general I have less control with fine motoric movements. Because of this I consulted the neurologist again in March. Then on clinical examination, she found slightly increased reflexes re>li, positive Hoffmann left, no callable abdominal skin reflexes, babinski indifferent bilateral. For her, no loss of strength. Blood was examined: negative. MR brain: negative. EMG: Positive sharp waves gastroncemius with also reinnervation signs gastrocnemius and hamstring(see attached EMG) - Since these are both at level S1, the neurologist went for the conclusion that it is a discal problem on S1. Also sensible carpal tunnel which could explain hand problems. Because of this, it was decided to take a wait and see approach and not to make a follow-up appointment.

Last months also occurrence of fasciculations on and off, mostly in the calves. But also in other muscles. Also my right leg and arm feels tired and oversensitive.

My question to you is certainly not for a diagnosis, but whether this is recognizable to you. With my clinical experience I have not seen it yet that motor failure is the first and most important symptom in a disc problem. Also other nerve tests are negative (lasègue, slump, ...). The symptoms are slowly progressive while I would expect it to be more episodic in disc problems.


Since everything else than MND is ruled out, I kindly ask for your opinion. Thanks in advance.
IMG-2446.jpg
Thanks
 

Nikki J

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Whatever this is ( and there are so many very obscure diseases I am not sure MND is the only thing left on the table) it seems very slowly progressing which is good. I am very slow progressing but my very early emg showed issues more widespread than yours.
hard as it is I think the neurologist’s advice wait and see is your best plan. No matter the outcome you will never get this time back so try to live your best life. Good luck
 
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