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Are Severe Pain And Numbness In Legs Signs Of Motor Neuron Disease?

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Posted on Fri, 17 Jun 2016
Question: Hi please let me start from the beginning.
Dad approximately 3 months tried to get up and simply couldn’t. Dad has always been an independent man with no mobility problems. We took Dad to the hospital who thought Dad had had a TIA. After assessment TIA was ruled out.
Dads main symptoms were severe pain in left thigh and leg and when he tried to stand up his legs would just collapse underneath him. Dad does have some numbness in his leg. This all started in his left leg but has now developed to the right leg (right leg is now much worse than the left with exactly the same symptoms, numbness, pain and legs collapse underneath him. Numbness in left leg has now resolved but still has it in his right leg. The numbness in right leg seems to be getting better but Dad can not stand as legs just wont hold my dad. Dads feet are always stone cold and he says he cant tell himself without touch whether both feet are hot or cold, recently dads feet are a little warmer. Dad has no upper limb symptoms.
At the moment Dad can’t get from a sitting to standing position yet his left leg now has full power and can leg raise with full range of movement. The right leg however he can not lift at all but can move it and has power in it, Dads left leg was like this at first but now the leg seems to be resolving though Dad can still not walk or stand.
We have had a follow up appointment with the Stroke Team who have now discharged Dad as they say his condition is not stroke related.
We have seen a Neurologist and are awaiting EMG studies plus MRI scan (had MRI scan now awaiting results) and Occupational Therapy input. Neurologist gave us no hope what so ever and said there is no treatment and reversing what is wrong with Dad. I am sure medicine these days there must be something.
There were no reflexes with dad but they do seem to be coming back a bit and you can see dads thighs like flutter.
Dad is currently in hospital and he is on vitamin drips

Please find below the letter we got from the Neurologist:

Diagnosis: likely diabetic motor sensory neuropathy

Thank you for referring this 68 year old right handed gentleman to the Neurology clinic. He has had Diabetes since 2000. His control was previously poor though has improved in the last 9 months. Mr Bridge has a previous history of osteomyelitis for which he was treated long term antibiotics (18 months of antibiotics). He now describes a 3 month history of progressive weakness of both legs. He also described numbness in the legs. His arms bowel bladder speech and swallowing is unaffected.

On examination today his cranial nerves were unremarkable. Examination of limbs revealed normal tone. Power was normal in both arms and legs. Hip flexion was reduced to 3/5 bilaterally. Reflexes were absent in the legs but present in the arms. Sensation to pinprick was reduced distally in the legs but was present in the arms. Vibration sense was absent up to the hips. There were no fasciculation’s visible.

I suspect this gentleman has quite a severe axonal motor sensory neuropathy secondary to his diabetes. I have explained that this is not a treatable condition but we need to exclude any more treatable condition but we need to do some further investigations to exclude anymore treatable causes. I am arranging MRI scan of lumbar spine to make sure there is no cord pathology or nerve root compression and some nerve conduction studies to quantify the extent of his nerve damage.

Questions:
1. Do you have any idea what is wrong with my Dads legs?
2. How can we get Dad XXXXXXX even with a Zimmer (Dad still falls with a frame)
3. Do you think this condition can resolve or get better?
4. If Dad can move legs freely whilst sat down why can he not stand up without legs collapsing or him falling?
5. What is axonal motor sensory neuropathy and do you agree this is what is wrong? Can it get any better?
6. What treatable causes are there?
7. Can dad walk again even with help of a zimmer?
8. This isnt motor neurone disease is it I am so upset and worried
doctor
Answered by Dr. Dr. Erion Spaho (3 hours later)
Brief Answer:
Damage of peripheral nerves by diabetes.

Detailed Answer:
Hello and thanks for being on HCM.

I have read your questions and understand your concerns.

It is not motor neuron disease, it is peripheral neuropathy that is causing your father's problems.

Peripheral neuropathy refers to damage of peripheral nerves by diabetes in this case.

The diagnosis will be clear after the examinations results.

MRI also will show if there is any contribution by conditions such lumbar canal stenosis, instability etc.

If the zimmer helps your father to walk, it certainly can be used.

Best treatment about this condition is control of the underlying causes ( diabetes in this case ) and physical therapy to strengthen leg muscles.

Hope I helped you.

Let me know if I can assist you further.

Take care.


Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Dr. Erion Spaho (5 hours later)
Dad can not stand will he ever be able to stand again
doctor
Answered by Dr. Dr. Erion Spaho (4 hours later)
Brief Answer:
Some improvement is possible.

Detailed Answer:
Hello again.

Some improvement in walking can be achieved by physical therapy, so discuss with your father's Neurologist about this possibility.

Hope I helped you.

Best regards.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 4494 Questions

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Are Severe Pain And Numbness In Legs Signs Of Motor Neuron Disease?

Brief Answer: Damage of peripheral nerves by diabetes. Detailed Answer: Hello and thanks for being on HCM. I have read your questions and understand your concerns. It is not motor neuron disease, it is peripheral neuropathy that is causing your father's problems. Peripheral neuropathy refers to damage of peripheral nerves by diabetes in this case. The diagnosis will be clear after the examinations results. MRI also will show if there is any contribution by conditions such lumbar canal stenosis, instability etc. If the zimmer helps your father to walk, it certainly can be used. Best treatment about this condition is control of the underlying causes ( diabetes in this case ) and physical therapy to strengthen leg muscles. Hope I helped you. Let me know if I can assist you further. Take care.