Possible first and second motor neuron symptoms

[franbejarano]

Hi, I'm 22 years old and I'm from Argentina, man. Sorry if the translation is not very good.

My concern started in April of this year since I began to feel clumsiness in my left hand. I did the studies requested by the neurologist and a first EMG of 4 limbs that said: "Denervation of the c8-t1 myotomes corresponding to the left 1st dorsal interosseous muscle." A week later I went back to my neurologist who, in the clinical examination, told me that he saw me perfectly and that the EMG result was something isolated, just don't worry me.

For the moment I calmed down but then I started with a lot of generalized fasciculations, I went back to the neurologist and he told me to continue without worrying. After a few days I began to feel my right quadriceps very hard, contracted and it is a feeling that has not gone away until today.

On my own I decided to repeat the EMG with another neurophysiologist, the results came out normal but he was suspicious because he only put the needle in the muscles on the right side of my body, that makes me wonder if it was not done badly or if something could have happened for high.

I went back to my primary neurologist and showed him the second EMG, he physically checked me again and told me to rest assured that everything was normal. I asked him about my discomfort in my quadriceps (now it was in both) and a feeling of swollen triceps that I had if it couldn't be spasticity or something first motor neuron and he said no. This was almost a month ago.

In this last month my quadriceps worsened, my right calf increased with the same sensation and my right arm is very swollen and stiff (biceps and triceps) when I touch it I feel differences with the other side in size and hardness and the fasciculations have multiplied a lot.

So I wonder if the EMGs were done well (due to fasciculations and clumsiness). Would there be enough time to detect/rule out second motor neuron failure? There was almost a 2 month difference between studies.

And my other concern arises from the feeling of swelling that has persisted for many weeks in my quadriceps and now also very strong in the right arm and calf. It makes me very afraid that this could be a 1st motor neuron problem.

I'll probably go back to the neurologist in the next month but what I'm feeling really terrifies me. I wanted to know your opinion or what you think of the EMGs performed and if what I feel in the muscles can resemble something of the first motor neuron or, failing that, what would these types of symptoms be like? Would they start off abruptly or very softly? And what does spasticity really feel like?

I have been reading this forum a lot and I really thank you!!

 

[AnxiousStatsGuy]

fasciculations, especially when generalized, are almost always benign. especially given your age.

a possible problem with your neck at c8 is exactly what you'd expect for a hand problem, depending which part. c6-c8 covers your whole hand.

your symptoms you describe are moving around too quickly, and it doesn't sound like any als case onset I've ever read about.

I am extremely confident when you see the neurologist next you'll be reassured. the symptoms you describe could be tons of things, but not really als.

cheers

 

[lgelb]

If your R arm is swollen and stiff, and it has not been evaluated by your primary care doctor, that is where I would go. They might want to have a physiotherapist evaluate what would be the best treatment. Remember, you can feel pain in one area that shows up in others, without any second cause.

Agree that there is no reason to think the EMGs are wrong, or to think that you have ALS. It is common that EMGs are done on one side, which may or may not be the area with problems depending on what the examining physician thinks is best.

Fasciculations, feelings, and "clumsiness" frequently have a common link that is not ALS or anything like it. It is called hypervigilance, and essentially it means that you become unusually aware of any troublesome feelings in your body, that usually you would not even notice or feel and move on, like when you stub your toe or start to trip but right yourself.

There is no point to discussing "what spasticity feels like." Ask your doctor to look at your arm and tell you if they associate what they see with spasticity. I doubt they will say yes, but even they do, spasticity is just a description, not a disease.

I repeat: you have presented no reason to worry about ALS.

 

[franbejarano]

Hello, thanks for answering!

It was just my general practitioner who referred me to the Neurologist, I already did all the possible studies and the only one that came out altered was the first EMG where it mentions: "Denervation of the myotomes corresponding to left C8-t1" I suppose that would explain the clumsiness of my hand at that time, it was not just a sensation. The neurologist said it was not very relevant, but since that day the twitching has increased a lot and I am concerned that the second EMG was only done on the right side of my body. Could that first denervation be the beginning of ALS?

Added to that is that sensation of contraction/permanent swelling from months ago that I feel in some muscles and I feel that it is altering my posture and making movement difficult, I am worried that they are symptoms of UMN.

At the moment I still have no clinical weakness.

Thanks for your time and responses

 

[lgelb]

ALS does not show up in C8-T1 and nowhere else. Its hallmark is showing damage on the EMG even in areas that seem to have no problems. That is why the second EMG was done on the R side. So if there were damage from ALS, it would have shown up in more places in both EMGs.

If you feel that movement is difficult because of a muscle problem, I would ask about an evaluation with a physio.

 

[franbejarano]

Thanks for your previous answers.

To this day I am still very scared and concerned that it is ALS with a UMN predominance.

My muscles feel worse than last time, with a lot of swelling and stiffness.

At the same time, movement problems have been added. It is difficult for me to extend my left index finger and dorsiflexion and plantar flexion of my right foot normally, I feel as if the muscles put a lock. In turn, at rest my right foot is in an unnatural position with respect to the left, it is something that bothers me even when I am at rest.

I really fear that it is spasticity and since all the studies carried out are good, only that horrible explanation would remain...

The following week I will see my neurologist (he is not a specialist) but I am really very afraid. Thank you for reading.