Presentation
OBJECTIVE: To study whether clinical characteristics can differentiate sporadic presentations of hereditary spastic paraparesis (HSP) from primary lateral sclerosis (PLS). [ncbi.nlm.nih.gov]
Presents a consistent chapter organization that delivers all the content you need in a logical, practical manner. Presents a new co-editor, Thomas D. [books.google.com]
We present 5 cases of progressive hemiparetic corticospinal tract degeneration, identified by the clinical presentation and the exclusion of other etiologies using serological, imaging, and electrodiagnostic studies. © 2015 S. [karger.com]
Respiratory onset can present with: Dyspnoea and orthopnoea. [patient.info]
Entire Body System
- Unable to Stand
SMA type Age at onset Motor Function Age at death SMA 0 Prenatal Unable to breathe, arthrogryposis SMA 1 Werdnig-Hoffmann disease 0-6 months Unable to sit SMA 2 6-18 months Unable to stand >2 years SMA 3 Kugelberg-Welander disease 18 months-3 years Able [neuropathology-web.org]
Inability to stand up from a seated position means that once seated you are unable to stand and maintain an upright position without the assistance of another person or the use of an assistive device, such as a walker, two crutches, or two canes. [ssa.gov]
The patient may be unable to stand up from a chair without help. Overall, the patient may exhibit mild to moderate limitation of function.16 In this stage, as with all other stages, the goal is to keep the patient physically independent. [the-medical-dictionary.com]
Respiratoric
- Hoarseness
; Hoarseness, reduced rate of speaking, slurred speech and drooling as the facial muscles weaken; Drooling and difficulties with swallowing and breathing late in the disease Occasionally, some patients suffer from speaking and swallowing difficulties [humanitas.net]
They include: Stiffness, weakness and spasticity in your legs Tripping, difficulty with balance and clumsiness as the leg muscles weaken Weakness and stiffness progressing to your trunk, then your arms, hands, tongue and jaw Hoarseness, reduced rate of [mayoclinic.org]
The symptoms of PLS usually progress over a protracted period of time and include: stiffness in the lower limbs lack of muscle strength weakness in the upper limbs and chest (the legs are usually affected first) slurred speech and hoarseness weakness [medic8.com]
Other symptoms include hoarseness, dysphagia, and slurred speech; because swallowing is difficult, salivation appears to increase, and patients tend to choke on liquids. [msdmanuals.com]
Jaw & Teeth
- Fasciculation of the Tongue
Fasciculations of the tongue, which are a prominent feature of SMA, are helpful in making this distinction. [neuropathology-web.org]
Bulbar onset: The first sign is usually slurring of the speech (impaired tongue movement). Wasting and fasciculation of the tongue. Dysphagia (usually a late feature with significant speech difficulties). [patient.info]
Within a month, the patient had slurred speech, difficulty in swallowing liquids and fasciculations of the tongue. [aafp.org]
Musculoskeletal
- Muscle Spasm
If your child develops involuntary muscle spasms or seems to be losing balance more often than usual, make an appointment with a pediatrician for an evaluation. [drugs.com]
The most commonly used treatments include: Medication: medicines may be prescribed to prevent muscle spasms. If medication is ineffective, a tap may be implanted to take medicine straight to the spinal fluid. [medic8.com]
Riluzole -slows the disease process -prolongs life -only drug approved by FDA Medications can be prescribed to help relieve other symptoms such as: Baclofen and diazepam-Spasticity Trihexyphenidyl or amitriptyline-helps swallow saliva Muscle spasms Muscle [quizlet.com]
Psychiatrical
- Loss of Initiative
Lower motor neuron loss causes initially increased electrical excitability leading to fasciculations, and later muscle weakness and atrophy; upper motor neuron involvement causes spasticity, clonus, hyperactive tendon reflexes, and Babinski signs. [neuropathology-web.org]
Neurologic
- Hyperreflexia
His neurological examination showed only mild facial asymmetry and asymmetric spasticity as well as hyperreflexia affecting the right upper limb. [karger.com]
Showing of 17 | 80%-99% of people have these symptoms Abnormal upper motor neuron morphology Abnormal shape of upper motor neuron 0002127 Babinski sign 0003487 Generalized hyperreflexia 0007034 30%-79% of people have these symptoms Dysphagia Poor swallowing [rarediseases.info.nih.gov]
Hyperreflexia and cognitive changes which are seen on neuropsychological testing can all be seen in the later stages of the disease. The experts have still not come up with any specific test that will properly diagnose primary lateral sclerosis. [ic.steadyhealth.com]
His examination was significant for hyperreflexia and spasticity in all 4 limbs, minimal voluntary movement of his upper extremities, lower extremity paresis, and dysarthria. [ajnr.org]
The diagnostic process consists of a history and physical examination, repeated at regular intervals, to document progressive hyperreflexia, fasciculations, and upper and lower motor neuron involvement. [aafp.org]
- Babinski Sign
Affiliated tissues include brain, testes and cortex, and related phenotypes are dysphagia and babinski sign OMIM : 58 Although primary lateral sclerosis (PLS) is similar to amyotrophic lateral sclerosis (ALS; 105400), they are considered to be clinically [malacards.org]
There are no standard laboratory tests for upper motor neuron disease, but spasticity (a specific type of stiffness), abnormally brisk tendon reflexes, Babinski’s sign and diminished fine motor coordination are seen as diagnostic signs on examination. [memory.ucsf.edu]
Showing of 17 | 80%-99% of people have these symptoms Abnormal upper motor neuron morphology Abnormal shape of upper motor neuron 0002127 Babinski sign 0003487 Generalized hyperreflexia 0007034 30%-79% of people have these symptoms Dysphagia Poor swallowing [rarediseases.info.nih.gov]
Hoffman's sign and Babinski reflex may be present and indicative of upper motor neuron damage. Treatment [ edit ] Treatment for individuals with PLS is symptomatic. Baclofen and tizanidine may reduce spasticity. [en.wikipedia.org]
Lower motor neuron loss causes initially increased electrical excitability leading to fasciculations, and later muscle weakness and atrophy; upper motor neuron involvement causes spasticity, clonus, hyperactive tendon reflexes, and Babinski signs. [neuropathology-web.org]
- Myelopathy
Radiation-induced myelopathy Type 1 Excludes myelopathy NOS ( G95.9 ) paralysis G12.20 ICD-10-CM Diagnosis Code G12.20 Motor neuron disease, unspecified 2016 2017 2018 2019 Billable/Specific Code meaning progressive muscular atrophy G12.21 Duchenne-Aran [icd10data.com]
Ever since, long-standing sceptical discussion has arisen from the observation that many patients with PLS seemed ultimately to have different diseases such as ALS, spinal multiple sclerosis, or cervical spondylotic myelopathy. [oxfordmedicine.com]
Type 1 (HTLV-1 myelopathy). [neurologyindia.com]
Spondylotic cervical spinal stenosis may produce myelopathy and associated LMN signs in the upper limbs. 94, 95 Thyrotoxicosis can produce a syndrome with mixed UMN and LMN signs attributed to combined myopathy, myelopathy, and motor neuropathy. 94 Vitamin [clinicalgate.com]
Dual pathologies: A cervical myelopathy and a co-existent peripheral neuropathy can present as a mixed upper-lower motor neurone picture. Sensory signs and symptoms and absence of bulbar symptoms help to diagnose this. [patient.info]
- Clonus
Lower motor neuron loss causes initially increased electrical excitability leading to fasciculations, and later muscle weakness and atrophy; upper motor neuron involvement causes spasticity, clonus, hyperactive tendon reflexes, and Babinski signs. [neuropathology-web.org]
Ankle clonus and Babinsky signs were elicited bilaterally. Lumbar puncture was negative for oligoclonal bands. Results MR mages were acquired on a Magnetom Sonata 1.5T scanner (Siemens, Erlangen, Germany). [ajnr.org]
All deep tendon reflexes were exaggerated with bilateral ankle clonus and Babinski sign. There was no sensory or cerebellar dysfunction. Routine hematological and biochemical investigations including chest X-ray were normal. [neurologyindia.com]
Muscle pain may be caused by clonus or hyperreflexia. Many patients complain of muscle cramps. As the disease progresses, immobility from weakness and spasticity predisposes the patient to painful joint complications. [aafp.org]
- Spastic Gait
[…] paraparesis 0007199 Pseudobulbar signs 0002200 Spastic dysarthria 0002464 Spastic gait Spastic walk 0002064 5%-29% of people have these symptoms Cervical spinal cord atrophy 0010873 Motor axonal neuropathy 0007002 Percent of people who have these symptoms [rarediseases.info.nih.gov]
He then developed a severe right flexion contracture of the right hand with progressive right lower limb spasticity and a spastic gait. [karger.com]
Workup
Mixed UMN and LMN or mainly UMN disorders resembling ALS are uncommon but are important to consider in the workup of patients with possible ALS. [clinicalgate.com]
Treatment
Offers practical, clinically relevant material for the diagnosis and treatment of musculoskeletal conditions. [books.google.com]
We combine internationally accredited hospitals, next generation treatments, unique products and services that are integrative and effective to ensure best possible treatment results. [globalstemcells.com]
Treatment Treatment for primary lateral sclerosis ( PLS ) focuses on relieving symptoms and preserving function. There are no treatments to prevent, stop or reverse PLS. Treatments include: Medication. [drugs.com]
[…] and support There is no cure for motor neurone disease, but treatment can help reduce the impact the symptoms have on your life. [nhs.uk]
[…] the other listing requirements despite this treatment. [ssa.gov]
Prognosis
PLS is a disease of the UMN, distinguished from ALS in prognosis and absence of LMN signs. [ncbi.nlm.nih.gov]
Pure primary lateral sclerosis and UMN-dominant ALS appear to have a more benign prognosis than typical ALS. Survival for patients with UMN-dominant ALS was intermediate between that of primary lateral sclerosis and classic ALS. [pallipedia.org]
This cautious approach is understandable, given the prognosis of the illness and the devastation that being given the diagnosis may cause to a person's life. [patient.info]
Prognosis A distinctive clinical feature of PLS is that it has a very slow progression, leading it to be considered to have a more benign prognosis in comparison to ALS [3]. [physio-pedia.com]
In 21 people with muscular atrophy in only specific parts of the arm, for more than four years, the prognosis was good: they were likely to survive for many years with little deterioration of muscle function. [alzforum.org]
Etiology
[…] maintain a repository of clinically characterized patients with primary lateral sclerosis for future research protocols, to characterize the natural history of neurodegenerative disorders with corticospinal neuron degeneration, to investigate proposed etiologies [clinicaltrials.gov]
We present 5 cases of progressive hemiparetic corticospinal tract degeneration, identified by the clinical presentation and the exclusion of other etiologies using serological, imaging, and electrodiagnostic studies. © 2015 S. [karger.com]
GEFs regulate the activity of members of the Ras superfamily of GTPases." [6] At least 10 deletion mutations and 1 missense mutation of the alsin gene have been shown to cause JPLS. [6] (See Etiology.) [emedicine.medscape.com]
Etiology ALS may have a multifactorial etiology or may result from a number of different neuronal insults. The major lines of investigation include genetic, viral, autoimmune 11 and neurotoxic hypotheses. [aafp.org]
Usually, etiology is unknown. Nomenclature and symptoms vary according to the part of the motor system most affected. Myopathies have similar features but are disorders of the muscle membrane, contractile apparatus, or organelles. [msdmanuals.com]
Epidemiology
Disease: Amyotrophic Lateral Sclerosis (ALS), Familial ALS, Sporadic ALS, Primary Lateral Sclerosis (PLS), Study Type: Observational Study Study Category: Epidemiology Study Status: Enrolling Phase : Not Applicable Study Chair(s)/Principal Investigator [neals.org]
We now have a fair amount of research in vitro and epidemiologically associating low levels of vitamin D with neurodegenerative disease,” said James Leverenz, MD, director of the Center for Brain Health at the Cleveland Clinic. [neurologyadvisor.com]
Epidemiological aspects of ALS are summarized in Table 66-1. [clinicalgate.com]
Epidemiology of ALS in Italy: a 10-year prospective population-based study. Neurology 72, 725–731 (2009). 10. O'Toole, O. et al. Epidemiology and clinical features of amyotrophic lateral sclerosis in Ireland between 1995 and 2004. J. Neurol. [nature.com]
Clinical epidemiology of amyotrophic lateral sclerosis. Neurol Clin. 1996;14:399–420. 10. Swash M, Schwartz MS. What do we really know about amyotrophic lateral sclerosis? J Neurol Sci. 1992;113:4–16. 11. Drachman DB, Kundel RW. [aafp.org]
Pathophysiology
Progress has been made in understanding the genetic defects and the pathophysiology of this crippling motor neuron disease (commonly called Lou Gehrig’s disease). [nejm.org]
ALS shares similar pathophysiologic pathways with multiple sclerosis, Alzheimer’s disease, and Parkinson’s disease. [neurologyadvisor.com]
Pathophysiology This is a degenerative condition that affects motor neurons, namely the anterior horn cells of the spinal cord and the motor cranial nuclei. [patient.info]
The investigation of the role of cerebellar structure in larger PLS population using structural and functional MRI can be of value in understanding the pathophysiology of the disease and its clinical and cognitive manifestations. [journals.plos.org]
Pain is addressed according to the pathophysiology of the problem causing the pain. [the-medical-dictionary.com]
Prevention
Discusses physical agents and therapeutic exercise in the prevention, diagnosis, treatment and rehabilitation of disorders that produce pain, impairment, and disability. [books.google.com]
Spasticity -Prevent contracture of muscles Low impact aerobics: swimming, walking, stationary bike -Strengthen unaffected muscles -Cardiovascular health -Decrease depression -Decrease fatigue Emerging Medical Treatment 1. [quizlet.com]
However, there are treatments and therapies that help to ease and prevent symptoms and improve quality of life. The most commonly used treatments include: Medication: medicines may be prescribed to prevent muscle spasms. [medic8.com]
The MSCs transplantation increases neuron survival and prevents gliosis, as microglia and strocytes are both the target and cause of neuroinflammation, MSCs can rescue neurons and oligodendrocytes from apoptosis through the release of trophic and anti-apoptotic [globalstemcells.com]
Stretching and strengthening exercises may help to maintain muscle strength, flexibility and range of motion, and to prevent joint immobility. Heating pads can help relieve your symptoms of muscle pain. Speech therapy. [drugs.com]