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Are Muscle Weakness And Difficulty In Swallowing Signs Of ALS?

Posted on Sat, 2 Apr 2016

Question: Hello, My mother had open-heart surgery with 5 bypasses 6 years ago. She has high blood pressure, cholesterol and of course a weak heart. She is highly medicated and has a low pulse rate, is lethargic, depressed and has very weak muscle strength. She can barely walk, but shuffles and scuffs her feet to move along. Ive heard that statin drugs can weaken muscle strength, but lately I've noticed her getting choked on liquids and a decrease in arm and hand strength. Last year, my mother-in-law died of bulbar ALS. We saw her loose her ability to swallow. We were told at the hospital that she possibly had myastenia gravis so we put her on a feeding tube to administer the medicine that would help this autoimmune disease. We also considered her having a plasma exchange. After 4 months of hospitalization and living in a rehab nursing facility, we were told she had bulbar ALS. I dont want my mother to suffer as my mother-in-law did with a mis diagnosis.
Should I seriously consider her muscle weaknesses and trouble swallowing as signs of ALS. As far as I know, her doctor hasn't even considered ALS a possibility, or at least, he hasn't told her of his suspicions? I will be with her at her next appointment. What questions should I ask concerning the possibility of her having ALS?

Answered by Dr. Ajay Panwar (26 minutes later)

Brief Answer:
Fasciculations/thinning of limbs-Neurological examination and EMG study.

Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.

Though,one can't diagnose ALS just on the basis of history still,a few important pointers in the history of ALS patients are Fasciculations(muscle twitch,tongue twitch) and thinning of limbs in addition to the weakness.

Besides,ALS is something,in which physical examination plays a very important role in diagnosis.Getting mixed lower motor and upper motor signs on examination are crucial to the diagnosis.So,Neurological examination will provide the clue.

Further,EMG(Electromyography) study gives the final evidence, and confirms the diagnosis of ALS.But getting an EMG is planned,only after a meticulous neurological examination.

So,in this case,I suggest you to get her evaluated on lines of a formal neurological examination,followed by the EMG study,if indicated.

Hope this helps.If you have any further questions,I shall be glad to have you in follow-up.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar