Question

What are some diagnostics for ALS?

Answer 1

Amyotrophic Lateral Sclerosis (ALS)

ALS is a progressive neurodegenerative disease of brain and spinalcord resulting in death of nerves that controls voluntry muscle movements. The disease causes weakness, atrophy, muscle spasm throughout the body due to upper and lower motor neuron degeneration.

Criteria for diagnosis of ALS

1. Signs of lower motor neuron (LMN) degeneration by clinical electrophysiological or neuropathological examination
2. Signs of upper motor neuron (UMN) degeneration by clinical examinations
3. Progressive spread of signs within a region or to other regions, along with the abscences of
   1. Electrophysiological evidences of other diseases that might explain the signs of LMN and UMN degenerations
   2. Neuroimaging evidences of other disease process that might explain the clinical and electrophysiological signs

Diagnosis

1. History and physical examinations: the causes of ALS is head injury, affected first degree relatives, but most of the cases thre is no strong causative factor. In the neurological examination if there is evidence of both upper and lower neuron symptoms it is suggestive of ALS. Progression of the signs and symptoms is the cradinal feature of ALS.The symptoms progress insidiously without any remissions and relapses. Signs of LMN is weakness, wasting and fasiculations in one or more regions ( bulbar, cervical, thoracic,lumbosacral regions). Signs of UND include increases tendon reflexes, pseudobalbar features, Hoffmans reflex and extensor plantar reflexes). Assess the progess of symptoms periodically.
2. Electromyography: to detect the electrical activity of the muscles. If the patient has poor electrical activity without the presence of other diseases suggestive of ALS
3. Nerve Conduction Velocity: It is helpful to rule out peripheral neuropathy and myopathy
4. Magnetic resonance Imaging of Brain and s[pinal cord (MRI): in initial stage of ALS the MRI is normal but it is helpfull to rule out tumours and other neurological diseases
5. Clinical laboratary examinations to rule out viral infections, other diseases.

Conclusion: there is no specific confirmatory examination sfor ALS. Diagnostic tests are performed to rule out other neurodegenarative diseases. In ALS the only way to diagnosis is periodic examination to findout the progress of the disease, because in ALS it is progressive in nature but in other disorders most of the cases there is relapses and relieves of symptoms.