question

[Applegreen]

Good Morning,

I am a male from the UK posting on behalf of my wife. Sorry to bother you all on here.

She feels she has had issues with her speech and swallowing for some time, this started in 2019. Her speech seems fine to me, however she does stumble on pronouncing certain letters at times, this has been going on for many years ( 6). She also occasionally chokes on food. I can see from her tongue that it appears different and there are twitches at times, however, she can move her tongue quickly from side to side and does not seem to have weakness. She also reports having issues with shortness of breath.

I know this sounds quite unusual due to the length of time the symptoms have been around but she has been referred to neurologist. (please note that she does have another neurological condition which is a genetic form of sensory neuropathy which affects her from head to toe) we are not sure if the inflammation from this is causing symptoms, my question would be would it be very unusual to be diagnosed with bulbar onset if having symptoms for some time and they have only progressed very mildly over the past 6 years? I could not find much online about this particular presentation. Thank you for your time. Richard.

 

[lgelb]

Yes, very. I cannot think of any such case.

 

[Applegreen]

Thank you for your reply. It is a little bit confusing...maybe it is part of her other condition which is rare in itself.

I presume you would expect significant problems after 6 years with pure bulbar palsy... sorry i don't know much about it..

 

[lgelb]

Yes, you would.
A relationship with her existing sensory neuropathy is certainly possible. When your foot is numb or tingling, for example, movement is certainly more difficult.

 

[Applegreen]

Good evening, my wife saw a neurologist last week. As I mentioned before she has an unusual nerve disorder diagnosed 10 years ago so they are unsure what is hoing in.. Her neurological exam was normal so presumably if she has had muscle symptoms for 6 years something would have been abnormal on the exam? The neuro ordered an emg and mris. Is this standard procedure, he seem rather confused

 

[Nikki J]

I would certainly expect someone with symptoms that were als to have an abnormal exam in some way even if it had not been 6 years. The emg and mri sound like the neurologist is being very thorough. She may well have abnormalities on her ncs/ emg given her pre existing condition. It is very important to remember that emgs can be abnormal in many ways and most are not als. Good luck and let us know when you have results!

 

[Applegreen]

I would also have expected the neuro to detect an abnormality in her speech if she is saying this has been a problem with this for over 6 years? . It does seem very strange. I will keep you posted. Thankyou Nicki