ALS Vs Radiculopathy

Patient

Q: Im a female 22 years old and i have some concerns. A week ago had i had an emg and ncs because of pain started 2 years ago and fasciculations starting 2 months ago. My doctor said that i Have bilateral cervical and bilateral lumbar-sacral radiculopathies.He ordered an MRI to see where are the locations of the pinched nerve. My question is could als be misdiagnosed as radiculopathy? I aked him about the twitching and he said is a common symptom of radiculopathy.But the thing is i have them on belly and face as well.But the truth is i had those after o notice and worries about twiching to be honest.So i dont know what to make of it. 1)Also what if someone both have radiculopathies and als? what difference lead the neurologist to believe its not als but radiculopathy? 2)also i noticed mouth paresthesia like buzzing or tingling in mouth and tongue?does this has anything to do with als or are this is how tongue fasciculations feel like? 3)if a patient has both radiculopathy and als can that be seen or suspected in the emg? 4)can radiculopathies cause buzzing and stiffness? 5)i ve read that radiculopathy can be confused with early als in an emg...how common is that? 6)Is constant fasciculation a symptom of radiculopathy? Thank you

Doctor

A:    ALS is a very serious disease; the clinical picture in all stages of amyotrophic lateral sclerosis (ALS) can vary and depends on the areas of the nervous system involved in each patient. Most patients with amyotrophic lateral sclerosis (ALS) die within 3 or 5 years of diagnosis, if they do not receive ventilatory assistance. There are diagnostic criteria for ALS, clinical and electrophysiological, which are very specific, besides ALS affects both motor neurons: upper and lower, while radiculopathy affects only lower motor neurons, meaning, the nerves exiting the spine, from here to any part of its peripheral path. In both, radiculopathy and ALS you may see in the EMG fasciculations and fibrillations. But the most important is that the differentiation between ALS and radiculopathy depends on the history and clinical presentation, for example: ALS has brisk reflexes while they are absent in the case a peripheral neuropathy. In some cases ALS is an elimination diagnosis, which is only made after we have ruled out other many conditions which can look very similar to ALS.

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