What are the common symptoms of motor neuron disease?

Question

Hello doctor,

I have been suffering from debilitating symptoms for the last seventeen months. I experience muscle-like pain on both sides of my ribs (diaphragm), and I have muscle pain in my back that has now spread to my shoulders. My neck feels weak, I produce too much saliva, and I experience muscle twitching all over, including my tongue. I fear I might have motor neuron disease (MND). Would the symptoms have progressed further by now if it were MND? I can still walk, talk, and eat, but I am in constant pain. I am scheduled for my second EMG next month. If that test is clear, is it likely not to be ALS after 18 months? Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

I am so sorry for what you are going through, and I understand your concern about MND (motor neuron disease). I am sure you know that making an exact neurological diagnosis, especially in a case needing clinical examination, is impossible via online consultation. In such cases, the only available evidence is from the provided medical history.

Based on your history, you suffer from spreading muscle pain, starting from your lateral chest area, some weakness, and muscle twitches across your body.

The fortunate feature in your history is the "pain". However, pain is not good generally, in case of suspicion of MND, having pain is good. Because motor neuron disorders (MND) do not cause pain directly. As your symptoms have started with a kind of muscle pain, the possibility of MND is very low. Nevertheless, the combination of your symptoms suggests a myopathic disease (muscle disease).

To judge the possible presence of a muscle disorder, I need to see your recent laboratory results (if conducted) and the EMG (electromyography) result.

I hope that you get your answer.

Please revert in case of further queries.

Thank you.

Answer 2

Hi

Welcome back to icliniq.com.

I understand your concern.

I am very pleased to hear that your lab tests and EMG results have been normal. I have thoroughly reviewed all the tables in your EMG-NCS report. The examination was conducted meticulously and comprehensively. I noted that the neurophysiologist even examined your tongue muscles, a crucial evaluation that is sometimes overlooked due to its discomfort and painful nature.

Please feel reassured, as it is nearly impossible for someone with ALS to exhibit a normal EMG in their limb, cervical, and oral muscles.

If your next EMG also returns completely normal results, you can be completely assured that ALS is not the cause of your symptoms.

However, some forms of MND may only present with upper motor neuron signs and have normal EMG-NCS results, but it is also nearly impossible for your condition to be attributed to these forms currently. In such cases, the clinical examination typically shows significant abnormalities from the onset of the disease, which are readily detectable by all neurologists. Please keep me informed about the results of your next EMG.

I hope that you get your answer.

Thank you.