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Welcome to Just Answer. I am an Adult Neurologist and was contacted to answer your question.
Hello I am waiting for you to come online for a chat session
as you are offline, I will switch this to the question and answer service, please get back to me with questions.
one of the things I could say to you online, is that in bulbar ALS, the pseudobulbar affect is present in up to 50% of patients
so emotional lability, meaning inappropriate crying, laughing,
I would ask if you have any of those symptoms?
No I dont have thosr symptons
also with bulbar forms, you can have ALS dementia, which is a subcortical type of dementia,
so you have problems of facial expression
spasticity in the face
or a spastic dysphonia
your language is really messed up
you sound like you have "hot potato" mouth
so I would not attribute dysphagia, without any other cerebellar signs or other cranial nerve signs to als.
I assume the other neurologists did not needle the tongue, because there is no atrophy or fasciculations
No I haven't had those symptons. But there is something causing this swallowing issue. I read that this can present in Bulbar ALS before other signs
you should have evidence of atrophy leading to dysphagia
so your pharnygeal muscles should be more flaccid, your uvula should be hanging
at least that is what I have seen in my practice life
do you have any of that?
do you have a gag reflex?
How would that be checked for? Thanks
when they put the tongue depressor in your mouth???
are you there?
I will switch this to the question and answer section, get back to me when you come back online
Please rate my service if satisfied. Dr Frank T
Yes I have a gag reflex, not sure about pharyngeal muscles...
Ihave been treated for 8 weeks with prevacid with no improvement which is why I fear bulbar ALs would the neurologists be so sure I dont just by exam that they woild do emg for Bulbar signs I am negative on my limbs as of 1 month ago
Isn't there such a thing as bulbar onset though so limbs test negative?
Update . Went to neuro today regarding swallowing problem. she checked my tongue for fasiculations test my babinski and a few strength tests I saw her a month or so ago, She said no ALS but did order a modified Barium swallow study and speech eval but why would she do this if no ALS
Went to ENT for follow up for reflux she looked back there with a small scope at my throat and vocal cords would she have seen changes if Bulbar ALS in my throat muscles
Since my previous Questions to you I have seen an expert in ALS at columbia presbyterian hospital in New York City. He did a full exam and looked at my 2 previous EMG's of limbs one 2 months ago and 1 8 months ago. He did a thorough neuro exam. Found negative babinski Hyperreflexia which I have had fior years But what scared me was positive hoffmans bilaterally. He told me I appeared very anxious and that I did not have ALS and did not want to do further testing inless other symptons developed. I wanted a EMG of tongue as I am convinced of bulbar as you know from previous posts, however he did not order one. I got the other neuro to order one for me at weill cornell on 8/8 will this help determine ALS I had a normal swallowing study.