UMN Symptoms

[planningguy]

While I sit in limbo waiting for the mitochondrial study to come back, I had a few questions about UMN symptoms. It seems that when discussing lower motor neuron symptoms (weakness, atrophy, etc.) there are dozens upon dozens of alternative causes and diagnosis that get tossed around. However the list seems much shorter when discussing UMN.

I have a handful of possbile UMN symptoms (trouble with swallow initiation and soft pallet, stiff upper face, mouth and cheeks seem to hug the teeth, "fat fingers" and lack of coordination).

For those of you with UMN or similiar symptoms:

1. What are some alternative diagnosed for these type of symtpoms?

2. What other types of things can cause UMN damage?

3. Is UMD damage permanent?

4. For those with diagnosed UMN problems, were the reflexes brisk from the get go? One reassuring thing for me is that my reflexes have always been good throughout this medical journey.

5. Do UMN symptoms come and go? I have always taken heart that every once in a while my hands feel "normal", and I have a much better day in terms of tongue and swallowing. Then I read a post in another thread that said it was very common for UMN symptoms to come and go (they were referring to slurred speech).

Thank you all in advance,

Robert

 

[crystalkk]

Robert,

What do you mean by fat fingers, are they swollen.

 

[sukilou]

Hi Robert....The only thing I can answer to your questions is #4, brisk reflexes. Mine were very brisk at my first neuro appt, Aug 07. I had been having symptoms since Jan 06, but didn't see a neuro until Aug 07 because of balance problems and many falls. At that time the doc noted brisk reflexes on all limbs, and at my last ALS clinic appt, they had increased (don't know what they were rated).

 

[BethU]

Hi, Robert ... Myasthenia Gravis (non-fatal, treatable, complete remission possible) has those bulbar-type symptoms ... swallowing issues, disarthria (speech), stiff face. In fact, I think it's called the "myasthenia snarl" (or else I just made that up) ... you lose the ability to smile properly because of a stiff face, and eventually your smile looks like a snarl.

MG generally gets worse as the day goes on, as the muscles tire easily. Fatigue and muscle weakness are characteristic. I believe that MG symptoms can also fluctuate from day to day, as well as differ from morning to night.

MG is an auto-immune disease, and blood tests for antibodies can diagnosed most cases, but about 10% don't show up in blood tests. I understand that an EMG cannot distinguish between MG and ALS. The difference between them is that the muscles don't die in MG as they do in ALS.

What happens in MG is that the thymus gland produces antibodies that prevent messages from the brain from getting through to the muscles. But the brain remains healthy, and so do the muscles. No atrophy. No permanent damage. So treatment is to eliminate the antibodies, which usually takes steroids, etc.

I'm sure there are other conditions, too.

 

[ptich]

1. There are a few, Multiple Sclerosis is probably one of the relatively frequent. MS usually comes with many other, non-motor symptoms, but I think there are forms that are mostly motor related.

4. My reflexes were normal (2+) at the first appointment 2 years ago, but they were brisk (3+) at the appointment several months ago. I have not read the last report yet.

5. My UMN symptoms always come and go, while atrophied muscles never get better. I think it is very typical.

 

[planningguy]

Thank you for the answers so far.

Crystalkk - No they are not swollen, sometimes it just feels hard to do detail work like untie a knot, or screw in a small screw.


Sukilou - Thank you. I've been working with my neuro since last March, and was feeling troublesome symptoms for about 6 months or so before that. My reflexes have always been fine (although he only checked my arms and for jaw jerk this last time).


BethU - Thank you for that possibility, and for the additional information. MG is one disorder I've thought about, but none of my doctors have mentioned. As I wrote in another thread, I think I want to encourage my doctors to run some blood tests again. Some of the ones the rheum was commenting on were over 6 months old at the time of the consult.

Isn't there another test besides a blood test that can check for MG. I seem to recall reading that there was a check they could do concurrently with an EMG. The trick is my EMGs have been clean.


Ptich - When I first started this process I thought MS because of the dizziness and some of the sensory issues. Most of those seemed to have resolved themselves when my B12 levels got sorted out, but I'm still curious. I haven't really gotten that many MRI's (one of my neck and another of my brain), and neither of them were performed with contrast.

My neuro still isn't calling what's going on around my wrist atrophy, but he did say he agreed with me that it was "different" in terms of tone from the other wrist. Is there any reason why UMN symptoms come and go?

Again thank you for the responses.

Robert

 

[BethU]

Robert ... I believe you're right, there is another MG test, but I can't think of it right now, sorry.

They gave me a CT scan looking for a thymoma, as this is connected to MG in a number of cases. When there is one, it's almost always benign, and removing the tumor can often cure MG, especially in younger patients.

There are 3 blood tests, for 3 different antibodies. Two related to AChr I think, and the MuSK, which is fairly new (one or two years old). I had a heck of a time getting the MuSK done. The neuro who incorrectly diagnosed me with MG (on the basis of no tests at all) hadn't even heard of it.

But that still leaves 10% of patients "sero negative," diagnosed only on the basis of clinical observation.

 

[hopingforcure]

The test is a single fiber emg. UMN would show pathologically brisk reflexes, I do not think they would ever be normal, very good sign. Sounds a lot like MG.

 

[planningguy]

BethU - Thank you for the followup. I am certainly following up with the neuro on the MG angle. It probably has not been considered to date because of the blood work and clean EMG, but maybe if we get more specific we'll nail it.

Hopingforacure - Thank you for answering the EMG question related to MG, as well as reflexes. That has always been a source of comfort for me that my refluxes are neither brisk (UMN progression) nor reduced (LMN progression). My local neuro is good at finding an opportunity to wack me with a mallet at least somewhere every visit.


Take care,

Robert

 

[BethU]

Robert ... there is another comdition to consider, but I hope you don't have to go there. It's LEMS ... Lambert Eaton Myasthenia Syndrome. Its symptoms overlap MG to a large extent. My first visit to a neuro, he wrote out some things he would be considering, and that was one of them.

LEMS is a precursor to cancer, usually small-cell lung cancer, but occasionally other cancers, too. It happens when cancer cells first appear and the immune system goes into overdrive trying to fight them. It's VERY rare. The only good thing about it is that it enables you to spot a cancer in its very earliest stages, and treat it aggressively.

 

[awieleba]

RObert~

I am envious of your "normal" reflexes! Where else are you gonna find someone who cares enough about your reflexes?

 

[ptich]

Robert, where did you read that LMN progression causes reduction in Deep Tendon Reflexes ? Could you please send a pointer ? I would assume that reduction / loss of reflexes could happen late in the course of the disease as a result of major muscle loss, but never heard that LMN damage reduces them.

 

[wright]

Robert

Sorry I haven't responded to your thread but I have been extremely busy as of late. It does look like you have gotten some good advice and responses, though. I will look over the thread more thoroughly when I have more time and see if there is anything I can add to it. Take care.

Ptich

The lower motor neurons are directly linked to the reflex pathway, so damage to them will diminish the reflexes. The more damage . . . the more dimished the reflexes until they become absent. The loss in muscle strength will also play a role but not the biggest role. That is why you can have a completely wasted and weak muscle with ALS and still have brisk reflexes (this is actually the hallmark clinical sign of ALS) because of the reflex mechanism over-riding the weakness.

The reason you have brisk reflexes is upper motor neuron dysfunction. The upper motor neurons innervate the lower motor neurons and influence the lower motor neurons. One of the big influences the upper motor neurons have is over the reflex pathway . . . and that influence is inhibitory in nature. Therefore, if your upper motor neurons are damaged, that inhibition will be lost and the reflexes will be over-active (i.e. brisk).

 

[planningguy]

BethU - Cancer is certainly a possibility. It runs strong on both sides of the family, and particularly males on my father's side (both paternal grandfathers died from cancer).

April - I know. I tell my wife my reflexes are normal, and she ruffles my hair and says, "That's nice dear. Can you pick up the boys from tae kwon do?" (JK She is an angel.)

Ptich - I hope Wright's answer helped, because it's a lot better than you would ever get out of me.

Wright - Thank you for diving in. I appreciate any insight you can provide. Like I said in the first post of this thread, UMN symptoms seem to have few imitators discussed.

Best wishes,

Robert

 

[KANSASTOM]

Wright, Would an increased gag reflex be part of an UMN symptom?