UMN symptoms in legs?

[Napoleon2386]

I’m a 32 year old female and for the last few years, my legs have become increasingly stiff/awkward to the point where I’m afraid to go down stairs without holding onto a railing. When I step down, my legs quiver/tremble, my ankle often bounces, then my knee locks and I lose balance. I’ve tripped/fallen several times.

I find it difficult to relax my leg muscles and feel like they are constantly tensing up. I saw a neurologist who said I had brisk reflexes but that was normal for my age. My legs quiver/tremble if I put weight on them with a bent knee, as if I just had a hard workout, but he said it was “due to conditioning” (I am 5’6 and 130 pounds, I walk for an hour+ daily as part of my commute, I’m not in excellent shape but I don’t think my legs should be shaking like this). I suffer from depression and the neuro brought up anxiety as a cause. I’ve been seeing a physciatrist for 5+ years and she has said I have very mild anxiety but not significant enough to be concerned about or warrant anxiety meds.

After tripping and falling down the stairs multiple times I went to see another neurologist. He confirmed I had diffuse hyperreflexia and also found sustained ankle clonus. He also said I had hypertonia in my legs. He commented that the prior neuro may have dismissed my symptoms due to my history of depression, but he suspected something else was going on. He ordered a cervical spine MRI and it was completely normal. He thought possibly MS, but brain MRI was completely normal too. He did a thoracic MRI just in case and that was also completely normal. He did an EMG as well which was also normal. He told me he was expecting the MRIs to show some clue and was surprised they were all normal. Now he wants me to come back in for a re-examination because clinical findings/symptoms are too abnormal for someone my age, but more common causes have been ruled out by the normal imaging.

I’m so frustrated because in my gut I feel something is not right, and my symptoms seem to be progressing very, very slowly. But could this all be in my head? My MRIs are all normal, my EMG is normal. Can hyperreflexia, sustained clonus and lower limb hypertonia be normal? I’ve read about PLS but it’s so rare there is limited information out there…I’m hoping to learn more from this community.

 

[affected]

It sounds like your new neurologist is on the ball and going to be thorough.
We are not doctors, so we can't really say what is going on. Your neurologist has told you that their findings point to things not being in the normal range, so I would suggest you make sure you have questions ready (put them in writing so you remember them all) to discuss all your concerns.

ALS has been ruled out. I would ask them if they are thinking along the lines of PLS or something else.

Let us know how that next appointment goes for sure.