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Progressive neuromuscular symptoms
July’08 felt progressive right calf stiffness and pain. Ketoprofen orally relieved pain but no stiffness.Had a bad cramp on right calf, neuro clinical exam. was normal as well as venous eco-doppler on both legs.Sept.’08 right arm weakness, another thorough clinical exam. with neurom.neurologist and brain CT, both normal,weakness disappeared after several days.Mid Sept' 08 “favourite neurologist” ordered extensive blood work, brain, cervical and lumbar RMN’s all normal.Sept.‘08 stiffness spread to left calf and right quadriceps,few widespread fasciculations.End Oct ‘08 stiffness on both upper forearms, neck, face, “favourite neuro” made thorough clin. exam.(normal).Clean needle EMG of legs.He put me on delorazepam 3 times a day, said it is psychosis together with BCFS.Medicine improved symptoms.Nov.’08 stiffness/slight pain on left emi-thorax,slight breathing difficulties on that side,Thorax RX, ECG,complete blood work,thorough clin. neuro examin. all negative.Nov.‘08 4 limbs clean EMG with neuromuscolar neurologist,told me it’s it’s a psychosomatic issue.End Dec.’08 pain in feet,clean 4 limbs EMG by a 3rd neurologist.End Jan.’09 stopped benzos,symptoms back almost totally.Normal thorough clinical exam. by "fav. neurologist" told me it is BFS/BCFS.
End Feb’09 went to neurom. neurologist reporting the same plus perceived light right hand weakness and minor occasional tingling/twitching external hand, made a thorough clinical examination (normal) told me IT IS NOT ALS OR MND. it a psychosomatic issue.End Mar’09 clean 4 limbs EMG by my 3rd neurologist, told me it is NOT BFS/BCFS OR ALS.Some weeks ago started feeling slight fatigue on right arm and right quadriceps and int. forearm and right thenar spasm/cramping espec. after exercising, stiffness of bottom of tongue like pulling it, tongue tremor (internal fasics?), occasional slight slurred speech and slight swallowing like lump in throat.Had Otorhinolaryngologist visit which was normal.Please advise me
End Feb’09 went to neurom. neurologist reporting the same plus perceived light right hand weakness and minor occasional tingling/twitching external hand, made a thorough clinical examination (normal) told me IT IS NOT ALS OR MND. it a psychosomatic issue.End Mar’09 clean 4 limbs EMG by my 3rd neurologist, told me it is NOT BFS/BCFS OR ALS.Some weeks ago started feeling slight fatigue on right arm and right quadriceps and int. forearm and right thenar spasm/cramping espec. after exercising, stiffness of bottom of tongue like pulling it, tongue tremor (internal fasics?), occasional slight slurred speech and slight swallowing like lump in throat.Had Otorhinolaryngologist visit which was normal.Please advise me
MEDICAL PROFESSIONAL
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
It sounds like over the past year you have experienced some limb stiffness, weakness, some bulbar symptoms (tongue and speech/swallowing trouble) and muscle twitching. In the setting of several EMGs (it sounds like at least 3) and MRI of the brain or spine, ALS or other MND and MS are highly unlikely as diagnoses. While imaging and EMG can not exclude all neurologic diagnoses, they do exclude many, and it can be said that an identifiable serious neurologic disorder is not present. Other diagnoses that can cause some speech/swallowing trouble with fluctuating weakness include myasthenia gravis, an autoimmune disorder, but it is likely the EMG would have shown an abnormality there. Other neurologic disorders that cause stiffness, such as spasticity (increased tone) and dystonia, would have been picked up by your neurologist on physical examination.
Your physician seems to have mentioned to you that often these symptoms may reflect emotional/psychiatric problems related to stress (what is called somatization disorder or psychosomatic symptoms). The latter is a true medical condition whereby instead of a patient experiencing depression or anxiety, they experience physical symptoms, and once the stress is addressed, the symptoms resolve. Sometimes, treatment with an anti-depressant/anti-anxiety medication can be helfpul. However it is important to understand that somatization disorder is diagnosed when other conditions have been excluded, so that continued follow-up with your physician is recommended.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
It sounds like over the past year you have experienced some limb stiffness, weakness, some bulbar symptoms (tongue and speech/swallowing trouble) and muscle twitching. In the setting of several EMGs (it sounds like at least 3) and MRI of the brain or spine, ALS or other MND and MS are highly unlikely as diagnoses. While imaging and EMG can not exclude all neurologic diagnoses, they do exclude many, and it can be said that an identifiable serious neurologic disorder is not present. Other diagnoses that can cause some speech/swallowing trouble with fluctuating weakness include myasthenia gravis, an autoimmune disorder, but it is likely the EMG would have shown an abnormality there. Other neurologic disorders that cause stiffness, such as spasticity (increased tone) and dystonia, would have been picked up by your neurologist on physical examination.
Your physician seems to have mentioned to you that often these symptoms may reflect emotional/psychiatric problems related to stress (what is called somatization disorder or psychosomatic symptoms). The latter is a true medical condition whereby instead of a patient experiencing depression or anxiety, they experience physical symptoms, and once the stress is addressed, the symptoms resolve. Sometimes, treatment with an anti-depressant/anti-anxiety medication can be helfpul. However it is important to understand that somatization disorder is diagnosed when other conditions have been excluded, so that continued follow-up with your physician is recommended.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
thank you very much for your answer. Basing on the info I provided you, you believe my symptoms could be more a psycological issue.I would like to be ensured that I do not have initial predominant upper motor neuron degeneration(costant progressive “patchy” stiffness and sometimes fatigue, little fluctuating but almost completely “masked” by delorazepam) which would develop into the complete form of ALS in the next months(because small rare cramps and widespread fasciculations I am feeling now could be the “prelude” of early lower motor neuron damage?!).I do have negative Babinsky, Hoffman, all deep tendon reflexes judged normal (last clinical neuro examination end of Feb.’09),no problems at Mingazzini I and II, but I know that in some cases these could appear positive in well developed/pretty advanced stage of motor neuron disease when deficits become really obvious (big troubles walking, speaking etc.).My concerns:
1) would it make sense doing in two months another EMG including cranial nerves (for my continuous odd sensation of tongue pulling/stiffness together with few fasciculations and weaker face muscles sensation) as well? (all my EMGs till now were made testing 4 muscles per limb, just sticking needle in only one point per muscle (not moving the needle inside it) for 10 sec. and then contracting muscle for checking recruitment.
2) Can recruitment be abnormal in Upper motor neuron damage and be picked-up during needle EMG?
3) How is possible that a psychosomatic reaction appear in such way, that is progressively involving my whole body, with many increasing number of different symptoms and on a steady “baseline”of muscular stiffness and fluctuating progressive cramps/fasciculations?
It is 9 months from my very first symptoms and my life quality now is extremely bad...
I thank you in advance for your immense patience with my report.
1) would it make sense doing in two months another EMG including cranial nerves (for my continuous odd sensation of tongue pulling/stiffness together with few fasciculations and weaker face muscles sensation) as well? (all my EMGs till now were made testing 4 muscles per limb, just sticking needle in only one point per muscle (not moving the needle inside it) for 10 sec. and then contracting muscle for checking recruitment.
2) Can recruitment be abnormal in Upper motor neuron damage and be picked-up during needle EMG?
3) How is possible that a psychosomatic reaction appear in such way, that is progressively involving my whole body, with many increasing number of different symptoms and on a steady “baseline”of muscular stiffness and fluctuating progressive cramps/fasciculations?
It is 9 months from my very first symptoms and my life quality now is extremely bad...
I thank you in advance for your immense patience with my report.
thank you very much for your answer. Basing on the info I provided you, you believe my symptoms could be more a psycological issue.I would like to be ensured that I do not have initial predominant upper motor neuron degeneration(costant progressive “patchy” stiffness and sometimes fatigue, little fluctuating but almost completely “masked” by delorazepam) which would develop into the complete form of ALS in the next months(because small rare cramps and widespread fasciculations I am feeling now could be the “prelude” of early lower motor neuron damage?!).I do have negative Babinsky, Hoffman, all deep tendon reflexes judged normal (last clinical neuro examination end of Feb.’09),no problems at Mingazzini I and II, but I know that in some cases these could appear positive in well developed/pretty advanced stage of motor neuron disease when deficits become really obvious (big troubles walking, speaking etc.).My concerns:
1) would it make sense doing in two months another EMG including cranial nerves (for my continuous odd sensation of tongue pulling/stiffness together with few fasciculations and weaker face muscles sensation) as well? (all my EMGs till now were made testing 4 muscles per limb, just sticking needle in only one point per muscle (not moving the needle inside it) for 10 sec. and then contracting muscle for checking recruitment.
2) Can recruitment be abnormal in Upper motor neuron damage and be picked-up during needle EMG?
3) How is possible that a psychosomatic reaction appear in such way, that is progressively involving my whole body, with many increasing number of different symptoms and on a steady “baseline”of muscular stiffness and fluctuating progressive cramps/fasciculations?
It is 9 months from my very first symptoms and my life quality now is extremely bad...
I thank you in advance for your immense patience with my report.
1) would it make sense doing in two months another EMG including cranial nerves (for my continuous odd sensation of tongue pulling/stiffness together with few fasciculations and weaker face muscles sensation) as well? (all my EMGs till now were made testing 4 muscles per limb, just sticking needle in only one point per muscle (not moving the needle inside it) for 10 sec. and then contracting muscle for checking recruitment.
2) Can recruitment be abnormal in Upper motor neuron damage and be picked-up during needle EMG?
3) How is possible that a psychosomatic reaction appear in such way, that is progressively involving my whole body, with many increasing number of different symptoms and on a steady “baseline”of muscular stiffness and fluctuating progressive cramps/fasciculations?
It is 9 months from my very first symptoms and my life quality now is extremely bad...
I thank you in advance for your immense patience with my report.
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