As of 2004, the underlying cause or causes for MMA remain unresolved. Most cases are sporadic and occur in an individual without a family history of MMA. Numerous factors—such as viral infection, vascular insufficiency (inadequate blood supply) of the spinal cord, heavy physical activity, radiation injury, traumatic injury, and atrophy of the spinal cord—have been suggested as possible causes of MMA. There are a few reports of familial cases of MMA.
Symptoms of MMA appear slowly and steadily over a period of time. The main features of MMA are muscle weakness and atrophy (wasting) in a portion of one limb. The weakness and wasting progresses slowly and may spread to the corresponding limb on the opposite side of the body. Symptoms can develop elsewhere in the affected limb or another limb at the same time or later in the course of the disease. Patients may notice worsening of symptoms on exposure to the cold. Other symptoms of MMA include tremor, fasciculations, cramps, mild loss of sensation, excessive sweating, and an abnormal sympathetic skin response. It is rare that individuals with MMA experience significant functional impairment.
Diagnosis of MMA is based on physical exam and medical history. Physical findings include reduced muscle girth (width around the arm or leg) and decreased strength in the affected limb. Tendon reflexes tend to be normal or sluggish. Cranial nerves, pyramidal tracts, sensory, cerebellar or extrapyramidal systems are not affected. Patients may report or display symptoms described above. They may also indicate difficulty carrying out activities of daily living such as writing, lifting, getting dressed, or walking.
Tests that may aid in diagnosis of MMA include electromyography (EMG), imaging studies such as magnetic resonance imaging (MRI) and computed tomography (CT) scans, and muscle biopsy. EMG shows chronic loss of nerve cells confined to specific areas of the affected limb. MRI has been reported to be a useful means of determining which muscles are affected in a given patient. Muscle biopsy shows evidence of atrophy of the neurons. EMG, muscle biopsy, or isometric strength testing may also reveal significant findings in seemingly normal muscles of the affected and the contralateral limb.
Dawn J. Cardeiro MS, CGC, The Gale Group Inc., Gale, Detroit,