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dtoq nos f smdde 1.
me nf
ryosthen iog ravis'Thlroid Fxn' ACeillCholiI\0
neceptorAntibodres i ncntf[f) : con,f irms Dr(-) : ooes not rlo
n6sen fn of0teino tec{roonofes i g(Q{ols tOrimmune dr\
'creqtinine Ki n0se (cK)t in AUS'.'iiiuitts musc I e ini'tnqle:
55-l1ofern0le t zo -ft6Hll\l,*ol,ltilo',, o'frters -
CSF ' .f lgc imnunogprotein ,-${6ccSF.electruPtplesrs :. t
rnmlelin nusic pnofetProsenS of IgGHrndSoliqoslonq I
bonds)eeriln@st ns Pdnents
Singl e {ruer il16 nostsensitireti{e netr6!sCUtorsPe(iflt t{)
tl6
roscirurqtrons o{the afosslJ Abnormol inoduonced drseose
AP lLqt CxR I Thlnomqor CT ECon CT i tdensitl of whit0rnqrter
qn0 nS p\qQue$r'rnt: Dfglldg for t4 sShorrs wnlte
ptqquesAbnorm0tvvitqt cqpocitl t a2r.'lillol lg rl'5 t )Tensilon
resT Se riot fl\uscle TKlrnq:$ofor streoqth de$ecit I v0rOd
P0ren+iql:0bnorm0ltmmed f 0re ty coof irmecf'1 FSpOnSe totiotlnbrg
19 crrug 5 Rqstcl or\c\inicot e,0iognostic tes+ tind
4 b't tuting out othercuuseg
-t 2 qilocxsseponoted infme ond smco'mRl elidencg)csr {indings)
evo[ed Porcntio-lr{rhg Ctio o ttoc
ALS ultipleSc\ eros iS 6uillqn
0orrgCSF: f ir\ proteinwlo f in cettcounTnofmol ll
mpho(lt8c0unt0lood Tests: wocll, leuRocYtOSf Sserurn:
q15y6iq,prtol
EMo qndNCv test sileqsurtg dectricolomqvirl i$
nusclell.$Pglffill"*
ruLobofot()fJTesl s
PFT'Sor A66's0+nerHOW IS
lqA, l{Msioor cutiurel c'JUunlDefive rt n0 t in qNeurtrporh
yoepressed veloflttes
0iognostic,lmoqinq
dfrer 3 weeRsoI come b0CKnorm0lt,lBrlCT to rlO drhercqu s es
tvitol copqgilyABGs: t Pq0nf PoCOr or -rphuo single Jindrngc(lnf
lrms clx.
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Nl0n e{est0ti00s M\oS+hen iqpNS 6 ro!is cNS ALS Mrrttip\effi S
c\ero St S 6 ui t\onpNs B0rf el,lot o r . elg.[l$g I
progressr\,grnt'scle weqKnes$tmpro{es T fest. P00f Postufg'ptt,
si'i-' jiPloPio'weqrllnqsnPtet etQCtoSUf0'imite turns to o snqr
I.Fociql weoKnesS'Ntst6gYnU g'EXtr00cul0rM0{e fl\entg
'Chqwinq lswqtl0N in9Di{ti c(rties. speech ( n0s0tTwofq'voice
recomes weoK)'. rongqe F issuf S. R e sp1 ro tori ComP rurust'Loss
o{ bowe\ f ntoddercont r0 ti"b. fotique
Eqntt s\mptorYls ::6niue ntrbphl'Fotiqu. urhi le tot rinq.
Drsoithr i0( Slurfed sp,' t..ltisql otlulft 1 of
'lolce'DlsPhoqiq.vulnrnelsinnunds {qrrn S. Beqinnttlqmugcleqil6phr
in orrns'FQsgicut utions (twitcnoT the fOceS I ll9fe sse s ''muscle
qtK,pht4rii.oi s eltern c' c lei do'),Respir0torl rruscl0lf\ {o t
tle$enfitspirotorl cornPftro'*Deqth
lFqtique I (qssoctote ntttcrr n i i dubus sensrti virlto
temperotune).Flexor Spdsmsotntgh'.hrentfon +re{nofs.r'oisrn et ri o
( illlllil*-n. ft$tiq ( I rrromr coord.), s(tv'rel latodderdtsf
xnS. il n t.t utr I r'xn(impotence''frtiicrl wegrness
4sPostlcltq'oisor+nn io "D'ts Phogtt.piptoPiq' rrrYsto$nuS.siofomos
( aperrP! )titstonpqrqt\ s ts cq n ueu.!J-g!g!gl I r'poor
coordfnqtroncrurns.| Moto r Mvmt St o n nr OefOctive eleeptendoii
ref lrts
.Ascendinqswmetntl t\^ot()fyuoKn0SSvriqccid poro tr
siSvltrtlou't mu S'clr otiroPhg'gor obSent cleep'*endon net lexeS'.
RespirotorJcomprornise t Fqiluf('LOSSOtnOrr.ret Qbtoddercon$o\ -(
tess comrn0n),Atoxiq ( vmotorcoordr'n o tlon )cront'o1 Nerve
tnvolv.. Focfot w0Q Koe
sS.0.'Sph0gt0'Drploptq.orfflcurrryspedHnq'hqbilitr tochew or -S
rnile
Senso rq .Muscle Achiness. PqrqSthe si 0\, tsme\\ {toste
$r nttectd4' 'tvf suol A treoningqc uit.f' P0r0srheti 0\..1,
sense 0t ternp''ri nnitus{ringing ineotS, dizzlness't,Hrp0l0esi0 (
t senS'iti'rtti to poin'\
p0rqsthestosPoin or cr1npinqsleep ql+erqilon3
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M\qstnenlqonoliS AL5 wlutriprgSclerosis ouitton-BqrrePNS CNS cNS
PNg
[9J o diseqse
Pothoph', s-iolog9Aqlttqntibodl 0ttocxln Ach RKePtff in
ttenuscle enOploftS\efve irnsltse oren'trmnsT\itted io
musclennzummUs3ul0r XXnnusiles con't controct
Ng lsguln Equset-oss ordeqth o0 trnntbreors
connecflonSwlunnN:SpoSt i ci t 1 rnrrruSclt
, lnf I qmfnfi0rJ respofis(dqm00es mletinSneo*h ,
lthtcnoesltJernr etenlzotlon\U cond'qct i on o S. i6pulSeS"Excict
(,qUSe unKno$r
Aut0immune qtto(Kon ff\..|etin ot peri'phero t nerveS{
conduction o.tlmpu r se sunKnown couq.0
Chqrqcrer izedbV?:0+rque ondweoxnessn rnutctes
rnnervotedrycr0niql ner{es.;getol dresPirotonfnusctesilemsess
weorness {,tnrgordipgt tOfl Exqcerhottons qncllernrssi onS,lu
eAscending eonotlsis,sudde n onset otrmuscl wsg(nessOnd
Poifi":eo+ures v0t'9.
E tioloq't IRlsK FoctotSltncidenct
PeqKAge : 20-30IrSwo$en lx > nenuor hercditonli6mitiol
incidenceRfifl
usu otl.rlo - rlo \fs^N\ A6E .tinCidente urltochdecq0eUSS )
vrofiio{\
n0st common newo.drsorder in oiderqduH)nS$ uSUql\r: 20
-tl0fri6"i["e n 7 6 g 11, rincidorilt aeqree
jglflilr0ieli1j:,.ilrcrqtrons
Mrddle ogedmen >wo/nenffi,n,hxo$qss0c.i l\ne sse sE ur0 .
Arner. > 0ther r0ct
Progfessi0 n 0nset : lnsiduos qsu0il
)eriodso 0gxqsTe s6qfrof\ {Rernissiont4uscle ArropnJ6eqlns
rflo0e'or {Spfeoc\s to entir0bod.,f . rncludinQreioirororr
mutcles
r,nodsot rBmrston 4:xosterbotitn nrnrchF rn s0{er\t lAf
requencg:qnrcodro pefrnonentdornnoe
Atuleonset (t-rlwFs).Plotequ ( uP to 2\lrt$Recover-l(usuol\1
q.til;i-,';i' ii-i.1eois\E voives 6ver noursto dqvs
cur0b I e tRem i Ssi on e N0 Knou,tn c ufgoeoth wtjn 3
ieorsrrp(o. Sor tu fe) ,10,, *noqr,l.No($\ot uit{
ExPecmncqwlrre0+ment Pt\Nrllffifill!!..trrp,utu.
Associq ted ir\nessesor rned icqt io n S.t,tc.
Flperplqsio ot therhlTIlUS
q\qndihlmonqrlpertnlroidtsmD-p$icillert0st, orinterferon- otPhO
6 xp\ori10 t0r0r-octions o'f
,.qenetic'iimt'envifonlnentqlq(ilrsqsposs inle cquses
PoSstnJu ttrqltnqgerlN0 s\nq\ertfUSrdrntiiied.
NUle ilhess- 6r itl-nessCqnpJ loboci ef f eJ u nt boctFr{ .
rnjcoptosmo pnetffi 0nl(Sufqerl, uR\r inut : d.rr mPqotov rfu s' i
iti'rii:Gii , {qrwet\ovocrinotron : Flu .6ltuPAStrgp' RobiesOruqg :
qOPtOPri t, Oonmo I
