Unclean Clinical Exam

[J4son]

I am not a doctor but isn't myotonic dystrophy a disease of it's own with a genetic origin? It runs families i think and cause mainly heart and vision problems (cataract). Prognosis sometimes can be good with MD depending on the severity of the condition. Anyway Juan I wish you the best and hope everything will be ok.

[misterjuanperalta]

Thanks all.

[mwagner]

I think a huge portion of this board has hyperreflexia + fasciculations and most doctors had zero concern and attributed the hyperreflexia to anxiety. Have you had an EMG?

[misterjuanperalta]

Yes, before the hyperreflexia, and clean. More EMG's and other tests forthcoming.

[dolphin8808]

I also have hyper reflexes and leg twitching in both legs (all over but mostly in legs). My doc is ordering an EMG simply for my peace of mind (his words). He did say that they only dig deeper into it when its asymmetrical or when there is NO reflex. My hyper reflexes could also be coming from the spine (as it is only in my legs that have it) which is another option for you to think of.

[misterjuanperalta]

Neuro told me the same. Babinski and Hoffman are normal for me. All other tests, except thenar (myotonia dystrophy), were normal. The bad thing about this new neuro is that he dismissed other neuro's tests. Rivalry? Perhaps. They knew and worked with each other before, unbeknownst to me.

[crotwich]

I am far from being an expert, but regarding hyperreflexia: What was your grading of myotatic reflexes upon tapping muscle tendon? If it was just 3+ (i.e. brisk response, without clonus) and if they were symmetric, this is still considered to be "normal" (and in fact a common finding in BFS patients, as few members already noted). Unless this new neuro detected some other UMN or LMN lesions (besides "hyperreflexia" and fasciculations), I find it highly surprising that he gave you a possible ALS diagnosis.

[misterjuanperalta]

Symmetrical is my impression and he did not comment on symmetry. Only hyperreflexia and fascics were detected. Any other findings would be diagnostic, MRI, blood, emg., which are pending.

[Sandra Q]

Did the neuro SAY I suspect ALS or is that what was written on the test requisitions? They have to write something to justify the tests.

[misterjuanperalta]

I don't know exactly what he did, wrote.

[garym]

hyperreflexia and fasciculations are very, very common here. The reflex changes seen here, are in my opinion, usually a result of anxiety and of course the fasciculations seen here are 99.9% always benign absent other sxs. So try not to worry about this to much right now. Sounds like the doc is just exercising an abundance of caution to me. Is he/she a neuro-muscular specialist? How did the doc dx myotonic dystrophy?

That you don't have "clinical weakness" is the best part of your above posts. While there are rare cases of fascics preceding weakness, it is very rare, and weakness almost always comes before other perceivable sxs. Hang in there, and let us know how things develop.

Take care,
Gary

[misterjuanperalta]

This neuro had a residency attending ALS patients. He suspected myotonic dystrophy when he struck both of my thenar muscles with his hammer and saw how they responded. I am not sure about neuro-muscular specialty. He also found my tongue twitches peculiar, wormlike and prolonged after stimulated while extended.

[misterjuanperalta]

Bloodwork and updates here: viewtopic.php?f=8&t=21622#p162527

[dolphin8808]

I am going to be honest, sounds like he is simply covering his ass and testing for everything possible. I mean WOW. Either that or he wants to wrack up the medical bills.

[Yuliasir]

i must say one of the fullest test panel I seen here.
General blood test, immuno panels for HIV, CMV, EBV (main viruses affecting nerves), tests to check chronic poisoning, lyme, autoimmune neuropathy, malabsorption of B group vitamines (maybe, not sure what is folate - probably level of folic acid absorption)

Full size brain MRI - from head to sacrum, double one - to see if any contrasting lesions are present (MS, radiculopathy, as usually ALS does not make any prominent changes on MRI)

Full size EMG - limbs and cranial nerves - which means you would be completely assesed for any LMN signs in all limbs and bulbar region.

EEG for seizures - really do not know why... if you have some epi activity - there would be quite different bunch of symptomes (usually fainting, absances, etc)... BFS people may have focal excitation partly similar to epileptic one (If I do not mess something, it was seen of fMRI, not on EEG), but I doubt anybody here had EEG as part of standard diagnostic panel.

at least I would say very deep investigation.