Amyotrophic Lateral Sclerosis (ALS) - CRASH! Medical Review Series 

I was diagnosed with ALS last August 2018 by my Neurologist. Went for a 2nd opinion from another Neurologist. He didn't think that I have ALS. Had a EMG test with the first Neurologist. The 2nd Neurologist sent me also for an EMG test with another Neurologist. After the test, the test Neurologist said things were very complicated, but he also felt I had ALS. After that I was sent to another Neurologist who was ALS Certified for an ALS Workshop. After all the tests at the Workshop, I finally saw and talked with the Neurologist. She was an older woman, definitely in her 50''s or early 60's. We talked, and I explained the issue's from all three other Neurologists. So she reviewed all the findings of all 3 other Neurologists. Plus all the blood work, and the 5 CT Scans of my head and back. My lower leg's and feet were still good, as was my upper body. The ALS Certified Neurologist asked me about my family and my personal medical History. One thing that got her attention was that I had Infantile Paralysis as a young kid. She then brought up Post Polio Syndrome. Which is often misdiagnosed as ALS. So as of now, I am still being tested to determine what is my problem. I was originally diagnosed with Lumbar Spinal Stenosis. So she just had me do another CT Scan, and is looking into also during a Muscle Biopsy on me also. I have now been going to my medical group for a year, and still no definitive answers. So if anyone of you have a History of Polio, don't totally accept an ALS diagnosis, until the possibility of Post Polio Syndrome is looked into. Because Post Polio mimics ALS.

This was a wonderful presentation.

great video. thanks for the effort

Great Presentation!

Your lectures are really helpful. Thank you so much 🌸

This is great I have a patient with primary lateral sclerosis (PLS) and that can be on the differential too.

Very amazing lecture.

In UK it's called motor neuron disease, MND.

Really useful review! Thx~

Great lecture,Thankyou so much!

Thank you!

My father in law was just diagnosed. Only been a few months since beating cancer. Weakness, trouble swallowing, getting winded very easily, shaking. Was told today at Emory that he’s probably had ALS for a couple years. 40% lung function.

Great presentation 👏 thank you sir

Amazing! I am so thankful for sharing your expertise and knowledge. Thank you so much! 11/8/2018

best review sir

Great video 🌹👍

Excellent

Sounds like sheldon cooper lol...otw greeaatt video, thank you soo much!

Good, thanks

thanks for ur lectures🥰

what about DDX of : 1) Cervical spodylosis 2) Myopathies reply needed.....

Neurology: Amyotrophic Lateral Sclerosis (ALS) is a Degenerative Disease, an Exclusively Progressive Neurological Deterioration of Both Upper Motor Neurons (UMNs) and Lower Motor Neurons (LMNs), and a Terminal Illness. Pathophysiology: Lateral Corticospinal Tract Degeneration (Most visible Autopsy Finding upon Histological Examination of the Spinal Cord). Pathogenesis is Insidious and Unrelenting Onset and Progression. Epidemiology: 1) 5,600 Annual Incidence. Aetiology is Idiopathic Causation. SSx: UMNs: 1) Primitive Reflexes as in Babinski Sign (Dorsiflexion of the Toes upon stimulation), 2) Hyperreflexia, 3) Spasticity, 4) Hypertonia, 5) Clasp-knife Reflex (Rigidity upon Physician's Attempt to Move the Arms of Patient Downward), 6) Pronator Drift; LMNs: 1) Fibrillation of Muscles, 2) Fasciculations of Muscles, 3) Hypotonia of the Muscle, 4) Hyporeflexia of the Muscle, and 5) Muscle Weakness (Myasthenia); Cranial Nerve Involvement: CN V (Trigeminal Nerve), CN VII (Facial Nerve), CN IX (Glossopharyngeal Nerve), CN X (Vagus Nerve), CN XII (Nervus Hypoglossus/Hypoglossal Nerve) yielding Dysarthria or Nasal Speech; CN X Involvement will show Hoarseness while CN X and CN XII will yield Dysphagia, a Difficulty in Swallowing and Choking. This Pathology also manifests a Pseudobulbar Affect Syndrome (PAS) or Inappropriate and Involuntary Laughing and Crying Presentation. Other symptoms: 1) Tripping (Limb and Gait Manifestations), 2) Stumbling, 3) Limp, 4) Hand Fatigue, 5) Cramping, 6) Stiffening (Ongoing and Progressive History). Uninvolved Musculature: 1) Bowel Muscles are unaffected, 2) Bladder Muscles are also not involved or Conserved. 3) Extraocular Muscles are intact. History (Hx): Family history (FHx) can be a Factor in ALS. Px: 1) Noticeable Limb Weakness, 2) Positive Babinski Sign, 3) Gait Abnormalities, 4) Muscle Atrophy, and 5) Nasal Speech; Diagnosis (Dx): 1) Clinical Diagnosis; 2) Most Accurate Test is an Electromyography (EMG); 3) Muscle Biopsy may be useful to Exclude other Possible Diagnoses. DDx: 1) Spinal Muscle Atrophy (SMA) is an LMN Symptoms and often Presents in Younger Patients or Infants. A Babinski Sign is Negative or Not Present; 2) Spinal Canal Stenosis has Sensory Symptoms; 3) Stroke will have an Acute Onset and will have inherent Risk Factors Present; 4) Guillan-Barre Syndrome (GBS) has an Acute Onset and will have a Characteristic CSF Morphology (High Protein without Cells); 5) Myasthenia Gravis (MG) has an Acute Onset and Involves the Extraocular Muscles and a History will show Autoimmune Likelihood (Autoimmune History: 1) Diabetes Mellitus Type I, 2) Rheumatoid Arthritis; 3) Crohn's Disease; 4) Systemic Lupus Erythematosus (SLE)). Prognosis is Poor with a 3 to 5 year Fatality Probability and Cause of Death is usually Aspiration Pneumonia (AP), a common Complication of ALS. Tx: 1) Supportive Treatment only as there is no known Cure for ALS; 2) NMDA Inhibitor Riluzole; 3) Muscle Relaxants Baclofan or Tizanidine for Muscle Spasm or Cramps; 4) Dextromethorphan/Quinidine for PBS; 5) Physical Therapy (PT) for Painful Contractures (LIgaments). 6) Anticholinergics for Excessive Salivation/Drooling; 7) Percutaneous Endoscopic Gastrostomy (PEG) Intubation for Feeding (Late Stage Treatment); 8) Non-Invasive Ventilatory Support for Muscle Weakness (Respiratory Distress of Late Stage); 9) Palliative Care Consultation (End of Life Planning) for Grief and Denial Possibility; and 10) Neurology Consultation. Code Status/Do-Not-Intubate (DNI) if appropriate should be attained. Goodness, My first ALS patient simply wanted an unimpeded Exit, without grief and turmoil but current Policy bars this approach. So Sad. Euthanasia must be. MD Paul Bolin, es geht immer gut aber diese Krankheit traurige und grosse ist. Prost!

Please include celiac disease common in the differential diagnosis Would you consider post polio syndrome in the differential diagnosis. I would think about using low-dose dexmethylphenidate facilitator for problems swallowing. Question: are there any common formulations I can exacerbate a nonsense mediated rna disorder I never ask my patients about whether they want to die , but do they have one reason To get out of bed in the morning they can, to live I would have all these patients valuated for nonsense mediated RNA decay disorder I thank you very much for putting together a well organized program making me think about what else I could do today to contribute to life Dr Bruce

Why doesn't anyone use a cause and effect approach to identifying the source of a problem rather than always trying to get a diagnosis?

What about the pathophysiology?

I have some problems with twitching all over my body, it started above my right knee and days later it was all over my body, feet, on different part of my legs, upper arms, shoulders, back, and stomach... I already went for a nerve conduction velocity which was fine , I wonder if ALS can start with twitching on random parts on the body ?

What a new treatment please tell me als mnd

cheers Dr Bolin, another great video. seems like an easy DX?

My brother has ALS. How much research is focused on the cause?

haha most accurate test while the patient is alive..... "oh we were wrong- it was lou gehrig's other disease after all". just playing around great job man.

Does tingling, numbness, and paresthesia present as beginning symptoms in some people with ALS?

Dr.Paul, at around 10:54, when you talk about the physical exam - I believe you meant "more APPENDICULAR weakness" (instead of axial) Great video, as always, saving my medical student career :)

Now I treating this patient very bad experience

gud video but there is no sound in d middle of d video.....plzzz upload videos which hav gud sound quality

Nice French Vanilla coffee?

I hope you know about Stephen Hawking

why not call this disease stephen hawkings disease. I have no idea who that baseball player is

How Stephen Hawking Survived so long when als was first diagnosed at 21 years and he should be dead by 25 -26 , but he died at 76 ... Is he is not suffering from als if yes how did he lived so long

You are a lad

Thanks so much Dr Alaho Olu on RU-vid first of all for who you are as a person thank you for the wonderful work that you do for people in general no matter where you are I will always listen to your podcast and refer people to you because you care about people and the human body I listen to other people but you talk about the true disturbances disorders that means things that are out of order in the human system thanks 🙏 for curing my Amyotrophic lateral Sclerosis disease (ALS)…

for me it's Stephen Hawking disease

What a new treatment please tell me als mnd