Mondays with Andrew Tara and Annie

Andrew’s Story Andrew, a 45 year-old single father of two, comes to you in confidence. He’s noticed that the muscles in his hands and feet have gotten progressively weaker lately, and from time to time, he sees these muscles twitch. He used to lift weights at the gym quite a bit, but he now has trouble lifting the bar. His daughter noticed that he seems to be tripping and stumbling quite often and commented that it took him quite a long time to get the key in the door the other day. Andrew claims that mentally he feels fine, but it’s almost like his muscles are slowly giving out on him. You don’t see any twitches going on right now, but you are having a hard time hearing him. He seems to be having trouble projecting his voice and his speech is slightly slurred at times. NOTE: To change images on this slide, select a picture and delete it. Then click the Insert Picture icon in the placeholder to insert your own image.

Signs and Symptoms Muscles in hands and feet have gotten progressively weaker Muscles twitch Trouble doing normal activities Tripping and stumbling Trouble projecting voice Slightly slurred speech

What do these Signs Point to? These signs and symptoms all conclude to one point: Amyotrophic Lateral Sclerosis (ALS) When we talked with him, Andrew said he had muscle weakness. This is a common sign. Slurred speech is a common symptom of ALS also. Click HereClick Here

Other Possible Diagnoses A possible other diagnosis could be Acute Dystonic Reaction (ADR) Common symptoms include muscle spasms and difficulty speaking Inconsistences though, are that he stumbles and talks quietly, also. Also, ADR normally occurs with neck stiffness and facial spasms, neither of which he has Another could be Parkinson’s disease Common symptoms that match with Andrew are difficulty walking and speaking Although these match, Andrew also has weak muscles. People with Parkinson’s disease also lose facial expressions and slow movement.

How We Diagnosed Andrew We started by simply ordering a blood test. We ordered a CBC and CK. When you are diagnosed with ALS there is an enzyme that leaks out, creatine kinase (CK), of damaged muscles. We also tested for genetic disposition to ALS. This eliminated Parkinson’s when the thyroid levels come back normal. We then ordered an MRI to get a detailed view of the muscles to see if we could rule out ADR. When the MRI came back normal, we ordered one last test to be sure. We ordered an electromyogram (EMG). We saw the motor nerves aren’t functioning, but the sensory nerves still are. It’s possible that Andrew’s thyroid could have been elevated which wouldn’t have eliminated Parkinson’s disease, but further testing would have shown that in the EMG the sensory nerves wouldn’t be damaged which would have then ruled out Parkinson's disease.

Prognosis Andrew used to be an active man, but the disease is already progressing. He has trouble walking and slightly slurred speech. Eventually, Andrew will lose the ability to walk or get out of bed on his own. In the late stages, he will even face difficulty breathing. Ventilation will help, but 90% of people with ALS die within 3 to 5 years from onset of symptoms.

Errors in Communication In ALS, motor neurons are attacked thus degenerating, ceasing to send messages to muscles. There is no known cause or cure for this fatal disease.

Even though we, Neurologists, are working hard on this case, we should bring in a few specialists to take a better look. Speech-Language Pathologist- helps the patient with ALS to maintain the functional communication and swallowing throughout the disease. ALS Specialist – helps to provide information to patients newly diagnosed Home Health Nurse- provide high tech care at home that was once only provided at the hospital

Treatment There is no cure for ALS, but the ice bucket challenge has helped further the research on it to hopefully find a cure for this fatal disease one day.