LMND - what is the difference with ALS/MND?

Status
Not open for further replies.

jethro

Distinguished member
Joined
Nov 2, 2017
Messages
430
Reason
PALS
Diagnosis
09/2017
Country
HR
State
Croatia
City
ZAGREB
low motor neuron disease - what is it? is it actually ALS, version of als, starting of als... often is MND/ALS, but low (no upper!) mnd put in google brings only als.
 

KarenNWendyn

Moderator
Forum Supporter
Joined
Jul 29, 2017
Messages
3,762
Reason
PALS
Diagnosis
07/2017
Country
US
State
OR
City
Southern Oregon
Lower motor neurons are in the brain stem and spinal cord. They receive signals from the upper motor neurons whose cell bodies are in the motor strip of the cerebral cortex (brain).
Lower motor neurons then send signals to peripheral nerves.

Lower motor neuron findings in ALS include weakness, atrophy, and fasciculations. Upper motor neuron findings include spasticity, hyperreflexia, and slowness.

Pure LMN disease is progressive muscle atrophy (PMA). Pure UMN disease is progressive lateral sclerosis (PLS).

Since ALS is a progressive disease, many people start out LMN-dominant or UMN-dominant and then develop more UMN and LMN features over time.

Most cases of PMA and PLS eventually progress to ALS, but those with these conditions seem to have a longer lifespan than people starting out with mixed UMN/ LMN disease.
 

affected

Guru status reached
Joined
Apr 26, 2013
Messages
13,906
Reason
Lost a loved one
Diagnosis
05/2013
Country
OZ
State
AU
City
lala land
ooops that's the Upper motor neurones :D
Lower motor neurons are in the brain stem and spinal cord.
 

Nikki J

Moderator
Joined
Mar 22, 2012
Messages
11,154
Reason
PALS
Diagnosis
04/2014
Country
US
State
MA
City
Boston
No , Karen is correct
 

jethro

Distinguished member
Joined
Nov 2, 2017
Messages
430
Reason
PALS
Diagnosis
09/2017
Country
HR
State
Croatia
City
ZAGREB
karen, thanks for answer. this is a most useful answer i got from anyone, including google.
why do i ask this?
1. neuro diagnose "ishialgia"
2. neuro diagnose (als expert) "according to all noticed results and criteria, it's als" (20 minutes of opservations which included reflexes and emg, forwarded to other rookies who confirmed it after reviewing of all negative results from mri, bloodtests, markers, etcetc, respecting als expert diagnose
3. physiatrist "LMD, according to emng results - emng lower and upper motor neurons compared in 8 last months". as i noticed, no upper neuron inervation found.
4. i've been sent to imunology-rheumatology-pulmology dpt after considering for decades non stop-elevated ALT, AST, newly measured CK (750) and kreatinine (within referent area, but reaching low level).

i talk to neuro (rookie), but he hears only what he wants. i never had any kind of problems upper from waist (weakness etc). "tongues fasciculations suspected, no visible atrophies on tongue, speech is little bit slower, whole left hand atrophy" even i said that i had elbow luxation and it was immobilized for 3 weeks... now,after 4 months it looks more than very good (muscles, power etc..). i have fasciculations all over my body, same as brief reflexes, 3+.
my right side is weaker for 21 years, since i had car accident, and they automatically connect it with spreading ALS. i work for 10 hours a day. sitting, just doing on comp, walking less than 1 km/day. so i have problems with walking for last 4 years which is worse and worse... that is all my problem. only misdiagnose can stop taking me appart from my girl.
 

lgelb

Moderator
Forum Supporter
Joined
Nov 5, 2009
Messages
10,653
Reason
Lost a loved one
Diagnosis
00/0000
Country
US
State
WA
City
Seattle
It's not like upper motor neurons control the upper part of the body and lower motor neurons control the lower part. Every muscle under voluntary control is controlled by many motor neurons, both upper and lower, in the way that Karen wrote about.

Most EMGs cannot detect upper motor neuron dysfunction. It is an emerging science that more advanced centers use.

So not having problems with the upper body, or not having them as much, does not mean that the ALS diagnosis was in error. The EMG shows problems in multiple regions even before there are symptoms, for the diagnosis to be made.
 
Last edited:

affected

Guru status reached
Joined
Apr 26, 2013
Messages
13,906
Reason
Lost a loved one
Diagnosis
05/2013
Country
OZ
State
AU
City
lala land
Thanks Karen.

I must have always understood it incorrectly, though when I search on this I find it confusing now, as some diagrams I'm finding on the net are just how I thought it went.

What I had always understood was this - UMN go from the brain to the spinal cord, LMN go from spinal cord to the muscles.

I think you are saying that the LMN go to the spinal cord and then it's the peripheral nerves that go to the muscles?

When I read what you wrote I thought you had literally made a typo, because of my obvious misunderstanding, and I'm still trying to get my head around it. Really appreciate your explanation :)

That moment when you realise you weren't lying, you were just plain wrong :lol:
 

jethro

Distinguished member
Joined
Nov 2, 2017
Messages
430
Reason
PALS
Diagnosis
09/2017
Country
HR
State
Croatia
City
ZAGREB
laurie,
i have problems with my legs. big problems for at least 2,5 years, started with minor problems year before /3,5 years). no further problems found. i had a problems, even emng was good. maybe wrong muscles opserved (?). right foot dropped, thumb on right foot curled, limp, muscles real atrophy just in legs, some muscle inervation in legs. dizziness i mentioned seems to be - waste of energy trying to concentrate to keep balance. my legs deteriorate on a daily bases for a two years, nothing else. my low motor neuron is affected as emng said for 5 times by now, but it should be visible somewhere&somehow in two years anywhere other then just in legs!
hence, i'm thinking of simple wheelchair, hand powered&controlled untill als spread to hands etc. by the way, it's easier to move arround a house&hospice with it.

last time i visited neuro he said&wrote "left hand atrophy and this is expected, but we couldnt prognose when it will happen". didnt hear what i was saying about luxation. i have appointment in a 3 days, so i'm very interesting what he will say. if he will say anything at all, except write.
 
Last edited:

KarenNWendyn

Moderator
Forum Supporter
Joined
Jul 29, 2017
Messages
3,762
Reason
PALS
Diagnosis
07/2017
Country
US
State
OR
City
Southern Oregon
Tillie, you’re correct in that UMN go from brain to spinal cord. LMN go from spinal cord to muscle — that is, they become the peripheral nerves.

Igor had posted an illustration in one of the DIHALS posts. I’m going to see if I can reproduce that illustration here (bear with me; I’m not positive this will work).

(see image posted below)
 
Last edited by a moderator:

KarenNWendyn

Moderator
Forum Supporter
Joined
Jul 29, 2017
Messages
3,762
Reason
PALS
Diagnosis
07/2017
Country
US
State
OR
City
Southern Oregon
Oops, that picture is not clear. Sorry.
If you go to Wikipedia and look up upper and lower motor neurons, you’ll find that and other nice illustrations.
 

affected

Guru status reached
Joined
Apr 26, 2013
Messages
13,906
Reason
Lost a loved one
Diagnosis
05/2013
Country
OZ
State
AU
City
lala land
Thanks Karen, I am really interested in the correct anatomy here. I've been involved with MND for more than 5 years and looked at lots of images of the structures.

So LMN go from spinal cord to the muscle, yet they are also found from the brain stem to the spinal cord? That's my confusion, I thought the ones going from brain stem to spinal cord were still the UMN?

Yeah that image was no good, try using the manage attachments function to upload an image rather than a link to one if you want to add images any time.
 

ShiftKicker

Moderator
Joined
Mar 16, 2015
Messages
4,519
Reason
DX UMND/PLS
Diagnosis
06/2015
Country
CA
State
BC
City
Vancouver
1212_Sensory_Neuron_Test_Water.jpg
 

KarenNWendyn

Moderator
Forum Supporter
Joined
Jul 29, 2017
Messages
3,762
Reason
PALS
Diagnosis
07/2017
Country
US
State
OR
City
Southern Oregon
Tillie, I looked this up (thank you — it’s good for me :) ).

My best understanding of it is that all the upper motor neurons originate in the frontal cortex (motor strip) of the brain. Their cell bodies are in that strip of cortex. These neurons have very long projections (axons), some of those reaching the brain stem, but some going all the way down the spinal cord.

When the axons of these UMNs reach the brainstem or spinal cord, they synapse (connect) with lower motor neurons. These LMNs then exit the brainstem or spinal cord as peripheral nerves and synapse onto the muscles to make them contract.

Tillie, to answer your question, the neurons exiting the brainstem are LMNs. Many of them form cranial nerves and serve muscles of the face and bulbar region.

Shiftkicker, thanks for the beautiful diagram.
 

ShiftKicker

Moderator
Joined
Mar 16, 2015
Messages
4,519
Reason
DX UMND/PLS
Diagnosis
06/2015
Country
CA
State
BC
City
Vancouver
Karen, I like my diagrams to be really big so I can trace them with my finger and talk myself step by step through it. Usually in private so people don't think I'm simple. Visual learner here.

Re: peripheral vs motor. My understanding is (incomplete) that they (peripheral nerves and the UMN/LMN) are separate yet inter-connected for proprioceptive reasons. The motor cortex takes information from peripheral nerves to help drive balance and assess "place". However, the peripheral nerves are not usually directly affected by motor neuron disease, only the motor control centre's ability to process/use the info gained from sensory/peripheral nerves. But that's also heading into ataxia territory, so my understanding is likely incomplete.
 

notBrad

Senior member
Joined
Feb 26, 2015
Messages
628
Reason
PALS
Diagnosis
04/2015
Country
US
State
OR
City
The coast of
Right click > save as...
 
Status
Not open for further replies.
Top