Slurred speech and foot drop

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mThompson

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Hi,
Just after some advice. My mum has had slurred speech and slight foot drop with weakness (she can't hop and her balance is a bit off) for nearly a year now. She has seen a neurologist who said they did not think it was ALS without offering much of a explanatory as to why, or what else it could be. Obviously we are all still extremely worried as just reading the symptom list it sounds like almost typical ALS. She has not deteriorated much if at all over the last 10 months and can still walk long distances and cycle on a exercise bike. I have always assumed ALS would progress faster than this but wanted to see if anyone had any information etc.
I appreciate that ultimately she will probably need to go back to the neurologist.

Much appreciated.
Michael
 

Nikki J

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It would be very atypical for ALS to manifest with a speech issue and a foot issue and nothing in between. It usually starts in one area and spreads from there. So a foot issue would typically progress in that leg for a while , then go either to the other leg or the arm on the same side as the leg. Hand/ arm issues sometimes go to bulbar next but that isn’t what you are reporting

were tests done? Did you accompany her to her visit so you really know what was said? Is she worried?

10 months is a long time to stay the same with ALS. It isn’t impossible though.

she should probably check with her gp and see what the report the neurologist sent said and decide with her gp whether she should see that neurologist again or someone else.
 

mThompson

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Hi,

Thanks very much for your reply, very useful. The symptoms are so far just isolated to the slurred speech and the right foot flopping (inability to hop on that foot) and balance issues with it. Unfortunately I was not present at the neurologist appointment but I know that they tested reflexes and basic strength tests. Although they did not look at the limb to assess atrophy and did not complete any EMG testing.
I have read the consultant letter to the GP, it is rather brief and states that they considered the neuro exam to be normal and that MND was unlikely and more likely a functional neurological condition. They didn't seem to consider the foot flopping as a weakness which I thought was strange.
My mum is extremely worried as the symptoms persist even if they have not deteriorated. I think perhaps an appointment with a different Neurologist might be the best option.

Thanks very much
Michael
 

Nikki J

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If they tested reflexes and strength they looked for atrophy. It doesn’t take prolonged gazing to see it. You can’t do relexes through clothes so even if she was wearing trousers they must have seen her leg
 

mThompson

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Thanks, in that case it sounds as though they must have tested it. My mum doesn't want an EMG so just have to wait and see.

In July I actually noticed basically constant twitches in my own legs and feet. These then spread to all over my body although not all the twitches are visible. I can even feel them in my scalp and mouth and nose sometimes. They vary day to day but are always there to some extent. I have some mild muscles pain / aches but no impact on speech or weakness in the limbs.
I went to see a neurologist and my neuro exam was normal. However, they suggested that as I was worried about it that they would complete an EMG and nerve conduction tests. These were completed in both arms and legs and were all normal apart from the odd fasciculation which they said were typical of BFS. The neurologist said this often occurs in people who have been concerned about ALS in some specific way. At that point I had been worrying about my mum for 6 months so I probably fell into that category.
They were very reassuring that it would not develop further into ALS so I am using that to control my anxiety about it. Hopefully that matches to what people on the forum think?
Nobody in my family has ever had ALS so if my mum does (hopefully not) then she would be the first in the family.
 

lgelb

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Yes, everything they said about your case is true. Try to stay on course with your life apart from your mom, and you will likely be less bothered by the BFS. I am sure your mum wants you to take care of yourself.

I hope she continues relatively stable. I would be curious as to whether a small stroke, clot or bleed was ruled out, especially if the speech issue and floppy foot presented at the same time.

Best,
Laurie
 

mThompson

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Hi Laurie,
Thank you for your confirmation, I can cope absolutely fine with the BFS so long as I don't start worrying about it progressing to ALS. The neurologist was actually very good and just stated emphatically that a clean and comprehensive EMG plus neuro exam means no ALS and it doesn't develop from twitches. So far that has worked well at stopping me worrying.
I am more concerned about my mum as she does have the 'typical' onset symptoms. If I am being honest I think she has deteriorated over the last 9 months. I noticed she can no longer run up the stairs for example and can't hop properly on one foot, plus has fasiculations in both legs. The foot and speech problem did seem to develop at approximately the same time, however, they did an MRI scan of the brain so I assumed that would have shown up a stroke or clot?
The obvious step would be to go back to the neurologist I saw but she doesn't want to so we will just have to wait and see.
Best regards
Michael
 
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