Questions, PLS?

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LuposMaximus

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Hello! Sorry to interrupt, I am a 26 year old man with neurological problems since January 2019. So it all started with muscle tremors all over my body, especially in my lower legs. I then started measuring my legs and my right calf is 1 cm narrower than my left and my right thigh is 2 CM narrower. We are now almost two years further, I try to go to the physiotherapist as much as possible but that leg keeps getting tired faster, stiff faster, it also vibrates very fast. I have had 3 mri's, a lot of blood tests and 6 EMG's in total. I am able to forward a report on the penultimate EMGs. The first two neurologists of the first 5 EMGs said that they could see something that caused damage, but that they could not see what caused the damage. Then I had to wait almost 9 months for an examination in one of the best neurological wars in Belgium, they have now taken an EMG a month ago and they saw nothing new of any new damage or deterioration, but now my question could this also be PLS? With PLS you also have 'clean' EMGs, don't you? There is not a very good explanation for this. If you wish, I can also send you the report of the previous EMGs. Thank you in advance!
 

lgelb

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Yes, if you could post the EMG report with identifying details concealed, that would be helpful.

Most often, PLS does result in a clean EMG but there can be slight evidence of lower motor neuron dysfunction. The good news is, there is no reason to think of PLS in your case. Slight differences between legs and changes over time are very common. PLS is very rare and causes disability, not just vibrations and tremors. Nearly 2y in from the first tremors, it is unlikely that you have an MND from what you describe at this point. I am curious as to how you came up with PLS at all.

I will withhold further comment pending seeing the EMG, but bear in mind also, there is not always an explanation. If the neurologists are seeing murky "damage" on EMG, with clean MRIs,that is consistent over time, whatever you have, it is progressing slowly if at all, which is a nice thought to go on with.
 

LuposMaximus

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Thank you for your answer!

This is the result of the third EMG, 2 October 2019, of which I have the papers:

The result: Nerve conduction: normal SNAP's nn surales, MCV's nn peroneales (CMAP right < left) and nn tib post (normal CMAP's). Normal MCVs and H reflexes S1 in length.

Needle examination: No resting activity, normal insertions. Interferential / Intermediate contraction trajectories myotoms L2-S2. Discrete acceleration and polyphasia Right m Tibialis Anterior and ext hall longus.

Conclusion: no more significant abnormalities in needle examination. Peristing small CMAP right N peronealis.

Decrease in EMG abnormalities, only smaller muscle response after stimulation right N peronealis on the left: Status after infection? In the past, borelia serology normal, i.e. viral? No refusals for an evolutionary or severe pathology. Furthermore, wait and see, if necessary check after 1 year so that the symptoms persist.



This is a result of the 5th EMG in March 2020. I do not have any research into this. Only results:

So clinical research: Stable neurological research. Diameter 10 cm above the knee Right 50 cm and Left 51 cm, 10 cm below the knee right 40 cm and Left 41 cm. Still normal / symmetrical strength and sensibility. Patellar reflex on the right < Left. Normal sole reflex, no fasciculations.

Conclusion: Minimal persistent complaints and discrete abnormalities during neurological examination, but normalisation of the EMG.


Of the other EMGs, there are also light summaries, I can add these if you like.

The sixth EMG and the last EMG was taken last month, I do not have any results yet, but the two doctors are that nothing new has come from the sun or something hasn't gotten worse.


Why I came to PLS? Because I have weakness and atrophy in that right leg and "clean" EMGS, don't I think? That's why I am thinking about PLS, because there hasn't been a single improvement in that yet. I have to stretch that right leg a lot, it is very quickly stiff, less supple or stretchable than the left leg. I find it difficult to crawl on my knees around my right leg. I can still climb stairs, walk on my toes. But if the physiotherapist wants to stretch that right leg, he also feels that the range of motion, yes, is smaller in that right leg. Tension builds up faster to put it this way.

I Cant upload the pictures of my phone from the EMG? Documents or to big?
 

lgelb

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PLS is very rare. It is not something you come to as a matter of course.

There is no mention of atrophy nor of clinical weakness in the notes, the combination of which would signal LMN dysfunction more than PLS anyway. So frankly, I am at a loss at to why you think you have anything neurologically wrong at all. The notes and reports say otherwise, and they specify a stable condition, not progression. A few mild abnormalities and a stiff leg say, let the therapist try to help your leg, not that you have PLS or anything close.
 
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