Dear Luca,

I am not a medical professional but I do research in ALS.

There are several conditions triggered by infections and toxic agents that are similar to  ALS in symptomology eg Guillain Barre Syndrome.  Some of these conditions resolve after a short period of time and others continue indefinitely.

ALS is extremely hard to diagnose quickly due to the large number of other conditions with overlapping symptoms.

The patient's disease progression will best indicate whether or not ALS is present.

Best Wishes

Casey

http://www.alsa.org/als-care/resources/publications-videos/factsheets/criteria-for-diagnosis.html

http://www.alsa.org/research/about-als-research/environmental-factors.html

Dear Casey,

many thanks for your advices. I will take a look to websites that you suggest.

All the best

Luca

Dear Luca,

If both upper and lower motor neuron (LMN) signs in bulbar and cervical regions are found, the diagnosis of ALS is almost certain. If only LMN signs can be found the differential diagnosis is broader. Toxics usually cause a distance-dependent neuropathy affecting both sensitive and motor nerves, which certainly does not match your description. A certain increase in ALS incidence have been found in US war veterans, but the ultimate cause remain unknown. A monoclonal band must be searched to exclude a lymphoproliferative syndrome.

Some ALS patients associate the begining of the disease with any kind of aggressions (surgery, falls, extreme effort, stress..) but their role as disease triggers have not been elucidated.

You can find further info about ALS mimics in this article (free available in Pubmed)

Pract Neurol. 2013 Jun;13(3):153-64. doi: 10.1136/practneurol-2013-000557. Epub 2013 Apr 24.

Mimics and chameleons in motor neurone disease.

Turner MR1, Talbot K.

Best,

Juan

I can suggest the cases of spastic paraparesis related to "tropical spastic paraparesis and human T lymphotropic virus I-associated myelopathy" and the rare instances of Chronic Neuroborelliosis mimicking ALS (Wien med. Wschr. 27: 1995: 186-188).

Best,

Marco Poloni

I agree. HAM/TSP should be part of the differential diagnosis. Consider also konzo. I am not aware of the epidemiology of Lyme disease in Africa. Schistosomiasis and other causes of myelitis may in the long run mimic ALS.  Keep in mind AR forms of hereditary spastic paraparesis in consanguineous populations.

I concur to consider HTLV-I. As well, there may be things like pellagra or a myopathy following malnutrition.

Many thanks to all your interesting suggestions. I will let you know when the case is solved.

Best wishes

Luca

Maybe this recent article could help: Association of Environmental Toxins With Amyotrophic Lateral Sclerosis  Feng-Chiao Su, PhD; Stephen A. Goutman, MD; Sergey Chernyak, PhD; et al. JAMA Neurol. Published online May 09, 2016. doi:10.1001/jamaneurol.2016.0594

Regarding a toxic origin I suggest to check heavy metals; recently I have seen a patient who lived in a region with abnormal thallium levels in the water; at the same time would be interesting to study the function of thyroid and parathyroid glands and to investigate the nutritional condition.