Primary Lateral Sclerosis: Difference between revisions
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<p><b>Original Editors </b>- John-Carlo Caballes, David Castro, Alana Griffith, <a href="http://www.physio-pedia.com/User:Joyce_Tan">Joyce Tan</a>, Joanna Van | |||
</p><p><br /> | |||
</p> | |||
</ | <h2> Definition/Description </h2> | ||
<p>Primary Lateral Sclerosis (PLS) is characterized as being a rare, non-hereditary, idiopathic, slow, and progressive degeneration of the upper motor neurons<span class="fck_mw_ref">Statland, JM, Barohn, RJ, Dimachkie, MM, Floeter, MK, Mitsumoto, H. Primary lateral sclerosis. Neurol Clin 2015 Nov;33(4):749-60. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26515619 doi: 10.1016/j.ncl.2015.07.007</span><span style="font-size: 13.28px;">. PLS lies on a continuum of sporadic motor neuron disorders. This spectrum includes other disorders such as progressive muscular atrophy, which involves only lower motor neurons, as well as amyotrophic lateral sclerosis (ALS), characterized by both upper and lower motor neuron involvement. Many patients diagnosed with PLS continue to have high levels of independence for many years</span><span class="fck_mw_ref">Gordon, PH, Cheng, B, Katz, IB, Pinto, M, Hays, AP, Mitsumoto, H, Rowland, LP. The natural history of primary lateral sclerosis. Neurology. 2006 Mar;66(5):647-53. doi: 10.1212/01.wnl.0000200962.94777.71</span><span style="font-size: 13.28px;">.</span> | |||
</p> | |||
= | |||
< | |||
< | |||
</div> | </div> | ||
<h2> Clinically Relevant Anatomy<br /> </h2> | |||
<p>add text here relating to <i><b>clinically relevant</b></i> anatomy of the condition<br /> | |||
< | |||
</p> | </p> | ||
<h2> Epidemiology<span class="fck_mw_ref">Singer, MA, Statland, JM, Wolfe, GI, Barohn, RJ. Primary lateral sclerosis. Muscle Nerve. 2007 Mar;35(3):291-302. doi: 10.1002/mus.20728</span> </h2> | |||
<ul><li>Approximately 2-5% of adults in neuromuscular clinics will be diagnosed with PLS. | |||
</li><li>The age of onset is approximately 50 years and older, though a juvenile form of PLS has been described as well. | |||
<h2> Epidemiology | |||
<ul><li>Approximately 2-5% of adults in neuromuscular clinics will be diagnosed with PLS. | |||
</li><li>The age of onset is approximately 50 years and older, though a juvenile form of PLS has been described as well. | |||
</li><li>Although the difference is not pronounced, there is a slight male predominance over females in being diagnosed with PLS. | </li><li>Although the difference is not pronounced, there is a slight male predominance over females in being diagnosed with PLS. | ||
</li></ul> | </li></ul> | ||
<h2> Etiology | <h2> Etiology </h2> | ||
<p>The exact cause of adult-onset PLS remains unknown<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />. PLS is a diagnosis of exclusion, meaning that individuals are diagnosed with the condition when their progressive upper motor neuron dysfunctions cannot be explained by any other possible cause. | <p>The exact cause of adult-onset PLS remains unknown<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />. PLS is a diagnosis of exclusion, meaning that individuals are diagnosed with the condition when their progressive upper motor neuron dysfunctions cannot be explained by any other possible cause. | ||
</p> | |||
<h2> Mechanism of Injury / Pathological Process<br /> </h2> | |||
<p>add text here relating to the mechanism of injury and/or pathology of the condition<br /> | |||
</p> | </p> | ||
<h2> Clinical Presentation </h2> | <h2> Clinical Presentation </h2> | ||
<p>PLS is due to upper motor neuron (UMN) degeneration, and therefore clinical presentation is consistent with signs and symptoms of an UMN disorder in the absence of lower motor neuron (LMN) symptoms<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." />. These include | <p>PLS is due to upper motor neuron (UMN) degeneration, and therefore clinical presentation is consistent with signs and symptoms of an UMN disorder in the absence of lower motor neuron (LMN) symptoms<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." />. These include: | ||
</p> | </p> | ||
<ul><li>Spasticity | <ul><li>Spasticity | ||
</li><li>Hyperreflexia | </li><li>Hyperreflexia | ||
</li><li>Weakness | </li><li>Weakness | ||
</li></ul> | </li></ul> | ||
<p>Other key features include stiffness and increasing difficulty maintaining balance with the progression of the disorder. PLS may affect the bulbar region in the medulla, causing degeneration to the lower cranial nerves<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." />. Bulbar signs and symptoms include | <p>Other key features include stiffness and increasing difficulty maintaining balance with the progression of the disorder. PLS may affect the bulbar region in the medulla, causing degeneration to the lower cranial nerves<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." />. Bulbar signs and symptoms include: | ||
</p> | </p> | ||
<ul><li>Dysphagia | <ul><li>Dysphagia | ||
</li><li>Dysarthria | </li><li>Dysarthria | ||
</li><li>Pseudobulbar affect/ emotional lability | </li><li>Pseudobulbar affect/ emotional lability | ||
</li></ul> | </li></ul> | ||
<p>PLS is classified as slowly progressive. The typical pattern of progression is spreading from side to side, region to region<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." />. It may start in the bulbar region and descend down to the limbs, or it may start in the lower extremities, progress to arms, and then bulbar region. Symptoms spread slowly over many years before plateauing<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." />.& | <p>PLS is classified as slowly progressive. The typical pattern of progression is spreading from side to side, region to region<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." />. It may start in the bulbar region and descend down to the limbs, or it may start in the lower extremities, progress to arms, and then bulbar region. Symptoms spread slowly over many years before plateauing<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." />.<br /> | ||
</p> | |||
<h2> Prognosis </h2> | |||
<p>A distinctive clinical feature of PLS is that it has a very slow progression, leading it to be considered to have a more benign prognosis in comparison to ALS<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />. The longevity of individuals with PLS is unclear, but it has been estimated to be 7.9 years or longer. Individuals with PLS and minimal EMG changes appear to have a decreased ability to ambulate independently in comparison to those without EMG changes. Nonetheless, patients may still be able to ambulate without aids after several years of being diagnosed. It is common for patients to be diagnosed with PLS but later diagnosed with ALS instead. Due to their similar course of progression, misdiagnosis can occur. A detailed spectrum of PLS categories have been detailed<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="gordon et al." /><span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />. | |||
</p> | |||
<h2> Diagnostic Procedures </h2> | |||
<p>add text here relating to diagnostic tests for the condition<br /> | |||
</p> | </p> | ||
<h2> | <h2> Outcome Measures </h2> | ||
<p> | <p>add links to outcome measures here (see <a href="Outcome Measures">Outcome Measures Database</a>) | ||
</p> | </p> | ||
<h2> Interventions </h2> | <h2> Management / Interventions<br /> </h2> | ||
< | <h3> Physical Therapy </h3> | ||
<p>Treatment for primary lateral sclerosis is symptom-directed<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />. The most common symptoms of someone with PLS include leg weakness, spasticity, spastic bulbar weakness, dysarthria, dysphagia, urinary urgency, and incontinence. Spasticity and muscle weakness are symptoms that can be treated by physiotherapists. Poorly managed spasticity can lead to soft tissue contractures, immobility, and a decrease in function | <p>Treatment for primary lateral sclerosis is symptom-directed<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />. The most common symptoms of someone with PLS include leg weakness, spasticity, spastic bulbar weakness, dysarthria, dysphagia, urinary urgency, and incontinence. Spasticity and muscle weakness are symptoms that can be treated by physiotherapists. Poorly managed spasticity can lead to soft tissue contractures, immobility, and a decrease in function. Physical interventions that include, active or passive movement (depending on which one the patient can tolerate), will help minimize changes in maintaining the range of movement and preventing the formation of contractures. Physical therapists may also consider splinting if the patient experience frequency spasms. Strengthening exercises prescribed by physiotherapists may also help PLS patients who experience weakness in their legs and decrease the high progression to gait aids.<br />Swallowing therapy may also be used in patients experiencing symptoms of dysphagia to prevent the progression of needing feeding-tube placement<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />. A focus on exercise-based swallowing intervention has been shown to improve functional swallowing and swallowing physiology. | ||
</ | |||
</p> | </p> | ||
< | <h3> <br />Medical and Surgical </h3> | ||
<p>Currently, there is no cure for primary lateral sclerosis. Therefore, treatment primarily focuses on relieving symptoms and preserving function. Depending on the patient’s presentation, treatments may include the following <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." /><span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />: | <p>Currently, there is no cure for primary lateral sclerosis. Therefore, treatment primarily focuses on relieving symptoms and preserving function. Depending on the patient’s presentation, treatments may include the following<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." /><span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />: | ||
</p> | </p> | ||
<ul><li>Oral medications such as balcofen, dantrolene, and tizanadine for muscle spasticity | <ul><li>Oral medications such as balcofen, dantrolene, and tizanadine for muscle spasticity | ||
</li><li>Surgically implanted balcofen pump | </li><li>Surgically implanted balcofen pump | ||
</li><li>Anticholinergic medication or botulism toxin injections for drooling | </li><li>Anticholinergic medication or botulism toxin injections for drooling | ||
</li><li>Feeding tube for dysphagia | </li><li>Feeding tube for dysphagia | ||
</li><li>Assistive devices such as walkers or wheelchairs for gait impairments | </li><li>Assistive devices such as walkers or wheelchairs for gait impairments | ||
</li><li>Physical therapy | </li><li>Physical therapy | ||
</li></ul> | </li></ul> | ||
<p>Ultimately, patients are best managed in a multidisciplinary motor neuron disease clinic where the various potential symptoms of primary lateral sclerosis could be comprehensively addressed<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />. | <p>Ultimately, patients are best managed in a multidisciplinary motor neuron disease clinic where the various potential symptoms of primary lateral sclerosis could be comprehensively addressed<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />.<br /> | ||
</p> | </p> | ||
<h2> Differential | <h2> Differential Diagnosis<br /> </h2> | ||
<p>As PLS is a condition that lies on a continuum of sporadic motor neuron disorders, there are several potential differential diagnosis. The 2 most likely upper motor neuron diseases that is associated with PLS are: | <p>As PLS is a condition that lies on a continuum of sporadic motor neuron disorders, there are several potential differential diagnosis. The 2 most likely upper motor neuron diseases that is associated with PLS are: | ||
</p><p>1. Amyotrophic lateral sclerosis<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." /> | </p><p><br />1. Amyotrophic lateral sclerosis<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." /> | ||
</p> | </p> | ||
<ul><li>ALS presents with lower and/or upper motor deficits and has fast(er) progression; PLS is slower progression and typically only affects upper motor neurons. | <ul><li>ALS presents with lower and/or upper motor deficits and has fast(er) progression; PLS is slower progression and typically only affects upper motor neurons. | ||
</li><li>ALS is more commonly associated with stiffness then PLS (47% vs 4%) | </li><li>ALS is more commonly associated with stiffness then PLS (47% vs 4%) | ||
</li><li>Both ALS and PLS can be assoicated with cognitive issues but is not present in its ‘uncomplicated’ forms | </li><li>Both ALS and PLS can be assoicated with cognitive issues but is not present in its ‘uncomplicated’ forms<span class="fck_mw_ref">Strong, MJ, Gordon, PH. Primary lateral sclerosis, hereditary spastic paraplegia and amyotrophic lateral sclerosis: discrete entities or spectrum? Amyotroph Lateral Sc. 2005 Mar;6(1):8-16. doi: 10.1080/14660820410021267</span> | ||
</li></ul> | </li></ul> | ||
<p>2. Hereditary spastic paraplegias<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="strong" /> | |||
</p> | </p> | ||
<ul><li>HSP has spasticity of the lower limbs; PLS is associated with spasticity as well and slight weakness but spasticity can affect speech (spastic dysarthria) | <ul><li>HSP has spasticity of the lower limbs; PLS is associated with spasticity as well and slight weakness but spasticity can affect speech (spastic dysarthria) | ||
</li><li>Complicated cases of HSP can result in dementia & mental retardation which may mimic cognitive issues possibly present in complicated cases of PLS. | </li><li>Complicated cases of HSP can result in dementia & mental retardation which may mimic cognitive issues possibly present in complicated cases of PLS. | ||
</li></ul> | </li></ul> | ||
<p>Other potential, but less specific, differential considerations include<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." />: | |||
</p> | </p> | ||
<ul><li>Structural lesions, especially related to the spine (eg. cervical spondylmyelopathy) | <ul><li>Structural lesions, especially related to the spine (eg. cervical spondylmyelopathy) | ||
</li><li>Infection (eg. HIV, syphilis) | </li><li>Infection (eg. HIV, syphilis) | ||
</li><li>Demyelinating disease (eg. mutliple sclerosis) | </li><li>Demyelinating disease (eg. mutliple sclerosis) | ||
</li><li>Metabolic / toxic (eg. vitamin E deficiency) | </li><li>Metabolic / toxic (eg. vitamin E deficiency) | ||
</li><li>Neurodegenerative (eg. Parkinsons and parkinson's-plus syndromes) | </li><li>Neurodegenerative (eg. Parkinsons and parkinson's-plus syndromes) | ||
</li></ul> | </li></ul> | ||
<p | <p>Special care must be taken when diagnosing as PLS can be misdiagnosed as the above examples, and many more.<br /> | ||
</p> | |||
<h2> Key Evidence </h2> | |||
<p>add text here relating to key evidence with regards to any of the above headings<br /> | |||
</p> | |||
<h2> Resources <br /> </h2> | |||
<p>add appropriate resources here | |||
</p> | </p> | ||
<h2> References | <h2> Case Studies </h2> | ||
<p>add links to case studies here (case studies should be added on new pages using the <a href="Template:Case Study">case study template</a>)<br /> | |||
</p> | |||
<h2> Recent Related Research (from <a href="http://www.ncbi.nlm.nih.gov/pubmed/">Pubmed</a>) </h2> | |||
<div class="researchbox"> | |||
<p><span class="fck_mw_special">Feed goes here!!|charset=UTF-8|short|max=10</span> | |||
</p> | |||
</div> | |||
<h2> References<br /> </h2> | |||
<p><span class="fck_mw_references" _fck_mw_customtag="true" _fck_mw_tagname="references" /> | <p><span class="fck_mw_references" _fck_mw_customtag="true" _fck_mw_tagname="references" /> | ||
</p> | </p> | ||
Revision as of 02:17, 5 May 2017
Original Editors - John-Carlo Caballes, David Castro, Alana Griffith, <a href="http://www.physio-pedia.com/User:Joyce_Tan">Joyce Tan</a>, Joanna Van
Definition/Description
Primary Lateral Sclerosis (PLS) is characterized as being a rare, non-hereditary, idiopathic, slow, and progressive degeneration of the upper motor neuronsStatland, JM, Barohn, RJ, Dimachkie, MM, Floeter, MK, Mitsumoto, H. Primary lateral sclerosis. Neurol Clin 2015 Nov;33(4):749-60. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26515619 doi: 10.1016/j.ncl.2015.07.007. PLS lies on a continuum of sporadic motor neuron disorders. This spectrum includes other disorders such as progressive muscular atrophy, which involves only lower motor neurons, as well as amyotrophic lateral sclerosis (ALS), characterized by both upper and lower motor neuron involvement. Many patients diagnosed with PLS continue to have high levels of independence for many yearsGordon, PH, Cheng, B, Katz, IB, Pinto, M, Hays, AP, Mitsumoto, H, Rowland, LP. The natural history of primary lateral sclerosis. Neurology. 2006 Mar;66(5):647-53. doi: 10.1212/01.wnl.0000200962.94777.71.
Clinically Relevant Anatomy
add text here relating to clinically relevant anatomy of the condition
EpidemiologySinger, MA, Statland, JM, Wolfe, GI, Barohn, RJ. Primary lateral sclerosis. Muscle Nerve. 2007 Mar;35(3):291-302. doi: 10.1002/mus.20728
- Approximately 2-5% of adults in neuromuscular clinics will be diagnosed with PLS.
- The age of onset is approximately 50 years and older, though a juvenile form of PLS has been described as well.
- Although the difference is not pronounced, there is a slight male predominance over females in being diagnosed with PLS.
Etiology
The exact cause of adult-onset PLS remains unknown<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />. PLS is a diagnosis of exclusion, meaning that individuals are diagnosed with the condition when their progressive upper motor neuron dysfunctions cannot be explained by any other possible cause.
Mechanism of Injury / Pathological Process
add text here relating to the mechanism of injury and/or pathology of the condition
Clinical Presentation
PLS is due to upper motor neuron (UMN) degeneration, and therefore clinical presentation is consistent with signs and symptoms of an UMN disorder in the absence of lower motor neuron (LMN) symptoms<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." />. These include:
- Spasticity
- Hyperreflexia
- Weakness
Other key features include stiffness and increasing difficulty maintaining balance with the progression of the disorder. PLS may affect the bulbar region in the medulla, causing degeneration to the lower cranial nerves<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." />. Bulbar signs and symptoms include:
- Dysphagia
- Dysarthria
- Pseudobulbar affect/ emotional lability
PLS is classified as slowly progressive. The typical pattern of progression is spreading from side to side, region to region<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." />. It may start in the bulbar region and descend down to the limbs, or it may start in the lower extremities, progress to arms, and then bulbar region. Symptoms spread slowly over many years before plateauing<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." />.
Prognosis
A distinctive clinical feature of PLS is that it has a very slow progression, leading it to be considered to have a more benign prognosis in comparison to ALS<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />. The longevity of individuals with PLS is unclear, but it has been estimated to be 7.9 years or longer. Individuals with PLS and minimal EMG changes appear to have a decreased ability to ambulate independently in comparison to those without EMG changes. Nonetheless, patients may still be able to ambulate without aids after several years of being diagnosed. It is common for patients to be diagnosed with PLS but later diagnosed with ALS instead. Due to their similar course of progression, misdiagnosis can occur. A detailed spectrum of PLS categories have been detailed<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="gordon et al." /><span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />.
Diagnostic Procedures
add text here relating to diagnostic tests for the condition
Outcome Measures
add links to outcome measures here (see <a href="Outcome Measures">Outcome Measures Database</a>)
Management / Interventions
Physical Therapy
Treatment for primary lateral sclerosis is symptom-directed<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />. The most common symptoms of someone with PLS include leg weakness, spasticity, spastic bulbar weakness, dysarthria, dysphagia, urinary urgency, and incontinence. Spasticity and muscle weakness are symptoms that can be treated by physiotherapists. Poorly managed spasticity can lead to soft tissue contractures, immobility, and a decrease in function. Physical interventions that include, active or passive movement (depending on which one the patient can tolerate), will help minimize changes in maintaining the range of movement and preventing the formation of contractures. Physical therapists may also consider splinting if the patient experience frequency spasms. Strengthening exercises prescribed by physiotherapists may also help PLS patients who experience weakness in their legs and decrease the high progression to gait aids.
Swallowing therapy may also be used in patients experiencing symptoms of dysphagia to prevent the progression of needing feeding-tube placement<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />. A focus on exercise-based swallowing intervention has been shown to improve functional swallowing and swallowing physiology.
Medical and Surgical
Currently, there is no cure for primary lateral sclerosis. Therefore, treatment primarily focuses on relieving symptoms and preserving function. Depending on the patient’s presentation, treatments may include the following<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." /><span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />:
- Oral medications such as balcofen, dantrolene, and tizanadine for muscle spasticity
- Surgically implanted balcofen pump
- Anticholinergic medication or botulism toxin injections for drooling
- Feeding tube for dysphagia
- Assistive devices such as walkers or wheelchairs for gait impairments
- Physical therapy
Ultimately, patients are best managed in a multidisciplinary motor neuron disease clinic where the various potential symptoms of primary lateral sclerosis could be comprehensively addressed<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="singer et al." />.
Differential Diagnosis
As PLS is a condition that lies on a continuum of sporadic motor neuron disorders, there are several potential differential diagnosis. The 2 most likely upper motor neuron diseases that is associated with PLS are:
1. Amyotrophic lateral sclerosis<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." />
- ALS presents with lower and/or upper motor deficits and has fast(er) progression; PLS is slower progression and typically only affects upper motor neurons.
- ALS is more commonly associated with stiffness then PLS (47% vs 4%)
- Both ALS and PLS can be assoicated with cognitive issues but is not present in its ‘uncomplicated’ formsStrong, MJ, Gordon, PH. Primary lateral sclerosis, hereditary spastic paraplegia and amyotrophic lateral sclerosis: discrete entities or spectrum? Amyotroph Lateral Sc. 2005 Mar;6(1):8-16. doi: 10.1080/14660820410021267
2. Hereditary spastic paraplegias<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="strong" />
- HSP has spasticity of the lower limbs; PLS is associated with spasticity as well and slight weakness but spasticity can affect speech (spastic dysarthria)
- Complicated cases of HSP can result in dementia & mental retardation which may mimic cognitive issues possibly present in complicated cases of PLS.
Other potential, but less specific, differential considerations include<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="statland et al." />:
- Structural lesions, especially related to the spine (eg. cervical spondylmyelopathy)
- Infection (eg. HIV, syphilis)
- Demyelinating disease (eg. mutliple sclerosis)
- Metabolic / toxic (eg. vitamin E deficiency)
- Neurodegenerative (eg. Parkinsons and parkinson's-plus syndromes)
Special care must be taken when diagnosing as PLS can be misdiagnosed as the above examples, and many more.
Key Evidence
add text here relating to key evidence with regards to any of the above headings
Resources
add appropriate resources here
Case Studies
add links to case studies here (case studies should be added on new pages using the <a href="Template:Case Study">case study template</a>)
Recent Related Research (from <a href="http://www.ncbi.nlm.nih.gov/pubmed/">Pubmed</a>)
Feed goes here!!|charset=UTF-8|short|max=10
References
<span class="fck_mw_references" _fck_mw_customtag="true" _fck_mw_tagname="references" />
