Are your muscles gradually weakening? Could this be Primary Lateral Sclerosis (PLS)?

Do you sometimes feel like your legs are a little heavy, like they're made of stone? Or do you feel like you're losing your balance when you walk, or your limbs are slowly losing their strength? If these symptoms don't come on suddenly, but gradually and gradually increase, it may be important for you to be aware of this condition called Primary Lateral Sclerosis (PLS). Don't worry, we'll talk about everything in simple terms.

Simply put, what is primary lateral sclerosis (PLS)?

Primary Lateral Sclerosis, or PLS for short, is a disease that affects our nerves and muscles. It causes our muscles to gradually, or slowly, weaken and/or become stiff.

Often, these symptoms first start in your legs. Over time, this weakness and stiffness can spread to other muscles in your body. This is a progressive condition, meaning that symptoms gradually worsen over time.

There is no specific cure for this condition (PLS), so treatment is mainly aimed at controlling symptoms and helping you to carry out daily activities more easily. For example, using an assistive device such as a cane or walker .

This is a very rare condition, meaning it is not commonly seen in society.

What is the difference between PLS and ALS?

You've probably heard of a condition called Amyotrophic Lateral Sclerosis (ALS) . While both diseases involve the nerves and muscles, there are clear differences between the two. To understand this, let's first take a look at how our bodies control movement.

There is a special type of nerve cell that carries messages from our brain to our muscles, we call them motor neurons . There are two types of these:

1. Upper Motor Neurons (UMN): These are the 'main wires' that carry messages from the brain to the spinal cord.

2. Lower Motor Neurons (LMN): These are the 'sub-neurons' that carry messages directly from the spinal cord to the muscles.

Now it is very important to understand this difference.

Early symptoms of ALS can be very similar to those of PLS. So sometimes a doctor may first diagnose you with PLS and then change it to ALS when symptoms develop that also affect the LMN. For this reason, to definitively confirm PLS, symptoms need to be observed for at least three to four years .

What are the symptoms of PLS?

Symptoms of PLS ​​come on very slowly. Here are some of the first signs you may notice:

• Stiffness of the muscles in the legs.
• Weakness of the muscles in the legs.
• Difficulty walking or having trouble maintaining balance.
• Muscle twitching or painful spasms or cramps.

As the disease progresses, other symptoms may appear:

• Muscle stiffness and weakness in the fingers, hands, and arms.
• Difficulty controlling urine (urinary urgency and leakage).
• Back and neck pain.

In very rare cases, the muscles of the tongue can also be affected. In this case, you may see symptoms like:

• Slurred speech (Dysarthria).
• Difficulty swallowing food (Dysphagia).

What causes PLS?

In fact, we still don't know the exact cause of PLS ​​in adults. Most of the time, it occurs randomly, without any apparent cause.

However, there is a very rare type of PLS ​​that affects children and young adults. It is caused by a genetic mutation (change in DNA).

The important thing is that PLS is not a hereditary disease. This means that you can develop it even if no one in your family has had it before.

Who is most at risk?

Anyone can develop PLS. However, patients are usually diagnosed around the age of 50. However, it can also develop in people younger or older than that. The condition is slightly more common in men than in women .

How is this condition diagnosed?

After learning about your symptoms, your doctor will perform a physical and neurological examination. They may also perform tests to rule out other conditions that have similar symptoms to PLS, such as ALS or multiple sclerosis. Some of these tests include:

• Blood tests: Check for other causes.
• Electrodiagnostic tests: This measures how well your nerves and muscles are working.
• MRI scan: Take detailed images of the brain and spinal cord to see if there are any other problems.
• Lumbar puncture (spinal tap): This involves taking a small amount of fluid from your spine and checking it for abnormalities.

What are the treatments?

As we've said before, there is no specific cure for PLS. Treatment is aimed at controlling symptoms and helping you live as independently as possible.

• Medications: Medications are given to reduce muscle stiffness, lameness, and difficulty swallowing (e.g. Baclofen, Tizanidine, Quinine, Diazepam).
• Physical therapy: Exercise is recommended to reduce muscle weakness, increase flexibility, and maintain good joint mobility.
• Assistive devices: Devices such as a cane, walker , or wheelchair are used to help you move around independently.
• Speech therapy: If you have difficulty speaking, it can help.

When should you see a doctor?

If you feel that your muscle stiffness or weakness is gradually increasing, be sure to see your doctor.

Also, if you have already been diagnosed with PLS and a medication you are taking is making your symptoms worse or causing side effects, tell your doctor about that as well.

If you are injured due to a sudden fall or accident, go to the hospital's Emergency Treatment Unit (ETU) immediately.

It's normal to feel depressed as your muscle strength gradually decreases and you can't do the things you used to do. If you're feeling stressed about these physical changes, talking to a mental health counselor can help.