ALS ?

[Artlaf]

Hello everyone,

I'm here to share some symptoms I've been experiencing lately, hoping to get some feedback or hear from others with similar issues.

I have clonus (involuntary jerks) in my left ankle, but it only lasts a few seconds and stops quickly.

I also have a palmomental reflex (chin twitch when the palm is stroked) on my right hand, but it’s weak and disappears quickly.

I feel pain under both feet.

I also have pain in my hands, especially when gripping or carrying things.

I don’t have a Babinski or Hoffman reflex.

My reflexes are slightly brisk, but nothing extreme.

The jaw (masseter) reflex is normal.

I don’t feel any spasticity (muscle stiffness), just some occasional discomfort in the fingers.

My neurologist told me that isolated clonus like this isn’t worrisome, but I’m still concerned because I’ve read that the palmomental reflex is almost always considered pathological and is often present in ALS, especially in the pyramidal form. I’d like to know if anyone has experienced similar symptoms and what it turned out to be.

Thanks in advance for your replies!

 

[lgelb]

The palmomental reflex is not that important. See The palmomental reflex: a useful clinical sign? - PMC

If you mean this ms:

https://rjn.com.ro/articles/2020.3/RJN_2020_3_Art-01.pdf

the fact that the reflex is common in ALS and even that it's more common in PALS than a control group does not mean that if you have it, you have ALS. For example, fatigue is common in ALS, too, but not everyone with fatigue, surely, has ALS.

I'd take your neurologist up on the opportunity to move on with your life. You might ask if physio could be helpful and/or try therapeutic massage. Different insoles/shoes may also help your feet.

 

[Artlaf]

Thank you for your response. Indeed, several studies have examined this reflex: some conclude that it is frequently pathological, especially when it is unilateral, while others offer a more nuanced interpretation. What particularly concerns me is the association of clonus with the palmomental reflex.

 

[lgelb]

If you mean the presence of clonus + this reflex, that probably describes millions of people.

Thus, your neurologist's comment still appears valid. You can waste your life cherry-picking medical literature when you fortunately have full strength and movement, or you can address your issues as per above.

 

[Artlaf]

Do you think it can be completely ruled out that this could be a pyramidal form of ALS?
What are the typical symptoms of this form, and how does it usually progress over time?
As for me, I’ve been experiencing pain in my hands and feet for the past six months.

 

[lgelb]

I do. I am not going to sketch out something that doesn't apply to you, though.
ALS does not present as hand+foot pain as you describe. I would ask your PCP about seeing a rheumatologist.

 

[Artlaf]

Thank you for your responses. I’m also experiencing fasciculations — or possibly myokymias, I’m not sure — (series of 3 or 4 rhythmic contractions) occurring throughout my body: calves, thighs, arms, and hands.
In ALS, are fasciculations typically localized, or can they appear all over the body?

 

[lgelb]

Typically, they are not widespread, because if they signify ALS nerve damage, that does not happen all at once everywhere. If the nerves died all at once, you would not be able to move at all voluntarily.

So that is another reason to not be concerned about ALS.

 

[Artlaf]

Thank you again for your response! I’m scheduled to have an EMG — if the muscles showing fasciculations are tested, and if those fasciculations are due to ALS, will the test detect it, even if the fasciculations aren’t present on the day of the exam ?

 

[ShiftKicker]

You might find this link informative. Read Before Posting. It has sections on both twitching and EMGs, as well lots of other answers. Please make sure to review it to make sure your questions are not already answered there.

To answer your question- the muscle does not have to be actively twitching for the EMG to detect problems. Twitches are caused by a whole variety of issues, but if they are caused by ALS, the EMG will detect it whether the muscle is actively twitching or not.

Please let us know how the appointments goes.

 

[Artlaf]

I had an EMG today, performed on about ten muscles (arm, leg, and tongue), and no abnormalities were found in the report. (One needle insertion per muscle — I’m not sure if that’s sufficient?). I feel much more reassured now —

Thank you again for your answers

 

[Nikki J]

Yes one needle a muscle is standard 10 muscles in that distribution sounds like a good and standard screening. You are good to go

 

[Artlaf]

One last question to fully reassure myself: If I had ALS in its pyramidal form for the past 8 months, would I already be showing obvious signs of muscle weakness or spasticity?

My physiotherapist thinks that the pain I feel under my feet might be related to leg stiffness (spasticity?), but I don’t clearly perceive this stiffness myself.

In this form of ALS, how does motor impairment usually manifest? Is it more of a feeling of muscle fatigue, or a true inability to perform certain movements?

Personally, I do feel muscular fatigue, but I’m still able to carry out my activities.

 

[Nikki J]

Yes.

Clinical weakness not feeling. The latter
Closing thread. You have been answered repeatedly. You had a normal emg. You don’t have weakness. Do not start another thread