A daft question

[Madge]

I feel stupid asking my question but I read so many messages on here regarding their diagnosis and it is confusing me.

is MND, ALS and PLS all different conditions?

I apologise for my ignorance as i feel i should know, perhaps I just never asked the right questions.

[Ellie]

Madge Not a daft question at all honey.

MND is an umbrella term for motor neurone diseases including ALS, PLS & PMA. xx

[Zante]

Madge I had to do quite a bit of reading up to get my head around the different terms!

Pls for me is upper motor neuron type of mnd. PMA I think is only lower. And ALS is both upper and lower.

My consultant explained the types and signs for each and also said pls can often change to als. Not sure if pma can change to als however. X

[SAMMY88]

It's even more confusing when seeing different neurologists who use different terminologies.

Anterior horn cell disease
Als
Mnd
Then the lowers neurons pma
Upper pls
Als both Upper and lower
Genetic sma, 1 to 4 types

The part I find confusing is the upper/lower motor neurons signs 🤨

[Ellie]

The part I find confusing is the upper/lower motor neurons signs

Signs of UMN damage usually include spasticity of the muscles (a stiffness and resistance to movement), brisk reflexes and a Babinski sign, (a reflex that is a sign of damage to the nerve paths connecting the brain to the spinal cord).

Signs of LMN damage include weakness, muscle atrophy (wasting), and fasciculations (muscle twitching). These signs can occur in any muscle group, including the arms, legs, torso, and bulbar region.


ALS presents with both UMN and LMN damage clearly evident, which is the classic, most common form of ALS which most of us have. In some cases, there is more UMN damage evident but some LMN damage nonetheless, and this is termed UMN dominant ALS and vice versa for LMN dominance.

PLS is when there is only UMN damage and none to the LMNs.
PMA is when there is only LMN damage and none to the UMNs.

Glossary:
UMN is Upper Motor Neuron
LMN is Lower Motor Neuron
ALS is Amyotrophic Lateral Sclerosis
PLS is Primary Lateral Sclerosis
PMA is Primary Muscular Atrophy

[Zante]

Ellie so well explained! Why couldn't most of the scientific articles be that well worded! Xx

[SAMMY88]

Ellie Thanks for explaining things, im gonna save that to refer back to. Wish the neurologists/ professors took the time to educate us .

It's the brisk reflexes I don't get. Like how fast is brisk 🤔 xx

[Ellie]

It's the brisk reflexes I don't get. Like how fast is brisk

Hmm, all I can say is that I have kicked some (young inexperienced) doctors as they examined my knee reflexes... 🤭

The term brisk has more of an 'active and energetic' meaning, rather than pure speed. xx

[TinyLady]

SAMMY88 like Ellie says, my brisk reflexes were hard to miss. Very strong, firm and determined movement I would describe them as and like Ellie I may have kicked a couple of people!

[SAMMY88]

TinyLady I dont have reflexes like you and Ellie describe. I don't have the babinski sign either. I would class mine as normal reflexes. I have no reflexes on both my ankles but all the rest normal.

[Ellie]

SAMMY88 Perhaps you have increased muscle tone - during the physical exam, you were probably asked to bend and straighten your legs several times whilst in a seated position and/or had your arms moved around.

I will say though that my knee reflexes weren't as dramatic/lethal in year 1 as they became in later years. xx

[Madge]

I don’t feel so stupid after all 😚 thanks Ellie for the explanation

[SAMMY88]

Ellie I was asked while laying down to rise my leg into the air, it immediately gave me whole leg cramps.

I just wish the professor would of gave me a running commentary . Why don't they share their thoughts we us , explain clearly what upper and lower motor neurons signs they find.

[Zante]

SAMMY88 from my examination I was told I had brisk reflexes, increased muscle tone, babinski on one side ( which went several months later to no reflex on the babinski test?!), hoffman's sign, spasticity, clonus in 1 ankle, and something called gegenhalten?.

But it wasn't explained to me at all however. I found this out in a clinical letter to my gp which I was copied into. The top of letter said Upper Motor Neuron Signs..

That led me to google. Mnd hadnt even been mentioned or on my radar at that point when I had first neurology consultant appointment. There were a list of about 8 conditions which caused umn signs. I thought then it was mnd or hsp before anything further like emg etc.

I don't know what usually happens I think from reading here that pretty much everyone had a different journey to diagnosis. I have to say though that I was seen exceptionally quickly and had mri within 24 hours of consultant and emg ncs within a month.

I still hope for something else missed like a tiny brain tumor that wasn't seen on mri! X

[Ellie]

Why don't they share their thoughts we us , explain clearly what upper and lower motor neurons signs they find.

My first Neurologist explained everything which I thought was normal.

My second Neurologist explained some things and I had to as questions which, after a while, prompted her to give me more information.

I'm quite sure I have annoyed some doctors by asking questions, but I'm not asking about their families or where they're going on their holidays, I'm asking about my body.

Perhaps it's a Power strategy... xx