Pre PACES Podcast #63 Motor Neurone Disease
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Jun 18, 2023 Dr Alex Thompson, consultant neurologist and MRC clinical scientist working on biomarkers and genetics of MND at Oxford, discusses motor neurone disease. He defines MND and its subtypes. He covers common presenting symptoms, key neurological signs, top differential diagnoses and essential investigations like MRI and EMG. He outlines multidisciplinary management, riluzole use, prognosis variability and current genetic and biomarker research.
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Start With Inspection And Bulbar Signs
- During exam, prioritise inspection: gait, aids (ankle-foot orthoses), wasting and fasciculations under good light.
- Check bulbar signs: tongue fasciculations/wasting, slow movements, jaw jerk and neck muscle weakness as helpful UMN clues.
Treat Sensory Findings As A Red Flag
- Sensory involvement argues against pure MND; if sensory loss is present, broaden the differential.
- Remember dual pathology can exist, but clear sensory signs should prompt alternate diagnoses like radiculopathy or neuropathy.
Distinguish Cervical Myeloradiculopathy From MND
- Top mimic is cervical spondylotic myeloradiculopathy; expect sensory signs and no neck muscle weakness.
- Use reflexes (e.g., Hoffman sign) and presence of neck weakness to help distinguish MND from cervical cord disease.