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Does ankle clonus indicate PLS? Clonus worsens with stress, EMG and NCS normal

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I would like to ask a question about ankle clonus for a friend. She has had clonus in her ankles for about 2 years along with widespread fasciculations and sensory issues. Her EMG and NCS were normal and bloodwork has not revealed anything. Her neurologist doesn't seem to be concerned about the ankle clonus, however, she is very worried about it because she thinks it is a sign of upper stress and better in times of reduced stress. Would this be the case if her clonus were pathological? Thank you. I'm just looking for something to reassure her.
Posted Thu, 3 May 2012 in Brain and Spine
Answered by Dr. Shiva Kumar R 11 hours later
Hello and Thanks for the query.

Regarding the ankle clonus, can occur in diseases which affect the upper motor neuron syndrome of long duration. In addition she has widespread fasciculations and sensory issues.

I feel it is not PLS (Primary lateral sclerosis )for 3 reasons. PLS does not have fasciculations.

The presence of it indicates it going for ALS (Amyotrophic lateral sclerosis ) . NCV (nerve conduction velocity ) and EMG (electromyograph) will be abnormal in ALS. If it is ALS ankle clonus is very rare or does not occur at all. Lastly sensory problems does not occur in PLS or ALS. So none of her symptoms are fitting in to ALS or PLS at this point of time.

Other reasons for clonus can be damage to the upper motor neuron system in the spinal cord or in the brain. Clonus rarely can occur in people with sever anxiety. Clonus is known to increase with stress. So if you have already scanned the spinal cord and brain and if normal, then we can think of other forms of degenerative disease in her other than PLS or ALS.

I am sorry your friend is dealing with this frustrating concern. But the possibility of either anxiety or some form of ongoing degenerative disease looks likely. Have another opinion from a different Neurologist to confirm my findings.

I thank you again for the query and hope you find this reply to be helpful and informative. If you have any additional concerns I would be happy to address them.

Take care, Bye
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