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JamesB

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When a limb fails because of ALS/MND- is it a gradual process or does it happen suddenly and then never works again?

If it's gradual, can you not lift things or stand with that limb but yet you can still move it around in bed or when sitting down? Like is it 'dead' from the first presentation of the problem or is there a limited range of movement for a few months that gradually becomes more profound?

Tx
 
. It is usually that a person notices something comparatively small. Fingers don't work to button a shirt, trip constantly because of previously unnoticed foot drop, can't do a calf raise. It is not a sudden loss of an entire limb, that comes gradually as the ALS spreads.
 
Thanks, Nikki. What's a calf raise?
Jx
 
Lifting a small cow.


No. Seriously. It means standing on your toes so that your calves are exercised.
 
lol..i noticed couldn't straighten small fingers on left hand..then atrophy in hand muscles..and cramping when trying to use a fork etc...a gradual process..
 
Sorry for another question- How long does that gradual process take? A few months/a few years until the leg/arm doesn't work?
 
in my case,,,which i'm thankful for my slow progression...it took nearly a year from first weakness,gradual atrophy and fasciculations appeared, till i couldn't eat with a fork,or use it to cut food.. other cases vary...
 
oh the fasciculations came after atrophy? I've had clinical weakness since March, but no one would notice yet. Though I cramp a lot
 
I'm waiting for an EMG/NCS - if these are clear (even though I've symptoms) is that a good sign that ALS isn't the cause? I've seen mixed things on the site about EMG problems being present from even before symptoms are obvious to the patient.
 
yep..if clear it;s good,,an emg can find lmn signs before they become apparent ...and point to many other conditions dependant on the translation of the neuro..
 
>Lifting a small cow.

lol
 
ha ha ha.. Just saw that response from Astugi.
 
VeggiePete- did you have pain in your fingers and hands when/before your weakness appeared?
 
oh the fasciculations came after atrophy? I've had clinical weakness since March, but no one would notice yet. Though I cramp a lot

Here's the way it works. First, a motor nerve in your brain is destroyed. Since it no longer feeds a muscle, that nerve pathway and muscle become totally useless, paralyzed, limp, and won't do anything anymore. Keep in mind that actions in the foot or hand use any of nearly 100 muscles, so one muscle dead can be seen as "weakening" of the limb, when in fact it is actually partially paralyzed.

The unused muscles loss their "muscle tone" so they appear gone where before you had a stiff useful muscle.

Second, the nervous system might try to recruit new nerves. This causes twitches for a little while as the nerves attempt to rebuild. But it always fails. More muscles get paralyzed until your whole extremity is limp and useless. Once paralyzed, a muscle never comes back; it's gone forever.

In this way described above, the process is gradual. However, most people won't notice it gradually, they'll just fall over or drop coffee cups and the weakness appears to be sudden. Also, if your doctor doesn't see "obvious and total weakness" in a muscle, it isn't ALS. Clinically, the weakness is undeniable, as the particular muscle involved has totally lost its nerve and suddenly cannot activate.

After being paralyzed awhile, a whole bundle of useless muscles may appear to be a dent or atrophied. But this doesn't always become apparent. When my wife was totally paralyzed, her muscle tone still looked quite beautiful.

All of this process occurs without cramping or pain. There is no sensory sign since the disease only affects motor nerves, not sensory nerves. The pain that ALS patients complain of is typically joint pain after being immobile for quite some time, or bedsores.

So by the time you notice the weakness, your EMG is already dirty.
 
very well written, Mike -- we should collect a primer on ALS -- we certainly have the material!
 
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