COMBINATION OF AMYOTROPHIC-LATERAL-SCLERO SIS AND MULTIPLE-SCLEROSIS

A twenty-five year old woman developed a progressive right hemiparesis which remitted within three months, without treatment The diagnosis w as a first relapse of multiple sclerosis. After a 10 year fully asympt omatic period, the patient developed weakness of the legs with falls a nd swallowing difficulties. Fasciculations and amyotrophy were present in the limbs and the tongue. There were no sensory abnormalities. The electromyogram confirmed the peripheral neurogenic degeneration with signs of anterior horn involvement. Motor and sensory nerve conduction s were normal. Muscle weakness and atrophy increased in the limbs and the bulbar territory and the patient died nine months later. The autop sy showed characteristic <<old>> plaques of multiple sclerosis in the cerebrum with anterior horn cell and pyramidal tracts degeneration, ty pical of amyotrophic lateral sclerosis, in the spinal cord. Although e xceptional this association of amyotrophic lateral sclerosis and multi ple sclerosis leads to the discussion of an etiological immunological dysregulation common to these two diseases.