Making a diagnosis

A careful history needs to be taken which includes family his­tory, problems during pregnancy or at birth. If the problem is of recent onset, contact, ingestion or inhalation of heavy metals, pesticides and other toxins should be covered. On examination a careful check needs to be made of the spine for signs of spina bifida. All modalities of sensation need to be carefully checked. Muscle power should be graded according to the Medical Research Council (MRC) Scale and a careful check made for signs of wasting, fasciculation and hyper-reflexia.

Investigations

Electrolytes should be checked routinely as imbalances in both calcium and magnesium can cause neurological problems. Electromyelographs (EMGs) and even muscle biopsies may be needed to determine the diagnosis. Imaging of the spinal cord and of the brain may also be required.