“This is a chronic, progressive form of spinal paralysis, characterized
by the symptoms of progressive muscular atrophy in the arms and by
lateral sclerosis or spastic paraplegia in the legs.” (Starr). It
is similar to progressive muscular atrophy, except, in addition,
there is sclerosis of the pyramidal tract. (See Progressive Muscular
Atrophy.) Osler classes progressive muscular atrophy of spinal origin,
amyotrophic lateral sclerosis and progressive bulbar paralysis as
diseases of the whole efferent or motor tract, wherein these disorders
may simply be various stages in the same case. He says, “A slow,
atrophic change in the motor neurones is the anatomical basis, and the
disease is one of the whole motor path, involving, in many cases, the
cortical, bulbar, and spinal centers.” There can be no question that
for the student, a classification of spinal cord diseases according
to the whole motor tract, the upper motor segment, the lower motor
segment, etc., is a scientific classification from our present
knowledge of the histology and physiology of the neurone, but for
clinical purposes the usual classification is given. Osteopathically,
we are greatly in need of a new nosology, either according to the cause
of the disorder or to the physiological disturbance.
=Amyotrophic lateral sclerosis= does not occur so frequently as
progressive muscular atrophy. Heredity plays a part, and it affects
older people. =Injury= to the =spinal column= is undoubtedly an
important factor. Exposure and cold may be exciting causes. Infectious
diseases and syphilis are probably important causes.
=Pathologically=, there are atrophy in the anterior cornu and sclerosis
of the crossed and direct pyramidal tracts. There is sclerosis of
centers in the medulla.
=Symptoms.=—Atonic atrophy, muscular weakness and fibrillary
contractions, of varying degrees, are characteristic. The reflexes are
exaggerated; the arm and leg muscles become weak and finally rigid and
atrophied. This results in deformity. Disturbances of sensation are not
pronounced. The sphincters may be slightly affected.
=Diagnosis.=—The disease is not so prolonged as progressive muscular
atrophy. Differentiation has to be made from multiple arthritis and
transverse myelitis and syringomyelia.
=Treatment.=—The same treatment as outlined for progressive muscular
atrophy is indicated. The disease may be retarded and life prolonged.