Motor neurone disease is a clinical diagnosis

Martin R Turner; Kevin Talbot

doi:10.1136/practneurol-2012-000374

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Motor neurone disease is a clinical diagnosis

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Shying away from making a clinical diagnosis
Nitin K. Sethi
Published on: 10 December 2012

Published on: 10 December 2012
Shying away from making a clinical diagnosis
- Nitin K. Sethi, Assistant Professor of Neurology
Turner and Talbot rightly emphasize that in spite of advances in EMG techniques and emergence of novel neuroimaging and CSF biomarkers the diagnosis of motor neuron disease (MND) still remains a clinical one.1 Find upper motor neuron (UMN) and lower motor neuron (LMN) signs in the same limb and MND should be high up in the differential I recall was taught to me in medical school. EMG was to be used in atypical cases wher...
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Turner and Talbot rightly emphasize that in spite of advances in EMG techniques and emergence of novel neuroimaging and CSF biomarkers the diagnosis of motor neuron disease (MND) still remains a clinical one.1 Find upper motor neuron (UMN) and lower motor neuron (LMN) signs in the same limb and MND should be high up in the differential I recall was taught to me in medical school. EMG was to be used in atypical cases where the diagnosis was in doubt. In today's world the pendulum has swung to the other extreme. UMN and LMN signs in the same limb-->could be MND--- >order a 4 limb EMG making certain that tongue and paraspinal musculature is examined-->then make the call-->definite MND Vs probable Vs possible. This over reliance on neuroimaging and neurophysiological data to make the diagnosis is not unique to MND; multiple sclerosis (MS) is another causality. Two discreet attacks separated by time (determined by history) and space (determined by examination findings) and the diagnosis of MS can be made confidently. No MRI brain, visual evoked potentials, somatosensory evoked potentials or oligoclonal bands in CSF are needed. How many of us do that now?
References
1. Turner MR, Talbot K. Motor neurone disease is a clinical diagnosis. Pract Neurol. 2012 Dec; 12(6):396-7.
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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