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Abstract Details

Uhthoff’s Phenomenon in Amyotrophic Lateral Sclerosis
General Neurology
P13 - Poster Session 13 (5:30 PM-6:30 PM)
6-004
To educate neurologists about Uhthoff's phenomenon. 
Presence of Uhthoff’s phenomenon in Amyotrophic Lateral Sclerosis (ALS), has not heretofore been reported. Such a case is presented.
Case study: A 71 year old right handed woman presented with a two year course of progressive reduction in strength involving both hands, shortness of breath upon exertion, difficulty walking, and nocturnal muscle spasms. After bathing in steam sauna treatment, she experienced immediate fatigue, worsening weakness, inability to walk along with worsening shortness of breath, which would last as long as a week.  This would reoccur after each sauna treatment.  When she discontinued use of the steam sauna, the exacerbation of weakness resolved.
Abnormalities in Physical examination: Neurological Examination: Cranial Nerve (CN) Examination: CN XII: Fasciculation of tongue with percussion myotonia of the tongue. Motor examination: Bulk: atrophy in bilateral thenar and hypothenar eminences and intrinsics. Percussion induced fasciculation and myotonia. Strength: intrinsics 4/5 in both upper extremities, 3/5 in bilateral abductor policis brevis, 3/5 right gastronomies and soleus. Gait:  Heel and toe unstable with circumduction of left leg. Reflexes: 1+ left brachioradialis. 1+ left triceps. 3 + bilateral knee jerks. 0 left ankle jerk. Positive jaw jerk. EMG: fibrillation, positive wave and fasciculation in all four extrimities, MRI of brain and spinal cord: hyperintense T2 flare in bilateral corticospinal tracts, left greater than right, in the brain. 
The mechanism of Uhthoff’s phenomenon in this individual may be an exacerbation of destruction causing dysfunction of the pathological white matter tracts of the corticospinal system, as opposed to impact upon the anterior horn cells.  In Uhthoff’s phenomenon, there may be a transformation of nerve conduction from saltatory to continuous conduction due to conduction blockade (Frohman, 2013). Given the above, it may be prudent to suggest those with ALS should avoid sauna baths or excessively hot bathing.  
Authors/Disclosures

PRESENTER 		No disclosure on file
Karla Licona, MD, MPH Ms. Licona has nothing to disclose.
Alan R. Hirsch, MD, FACP (Illinois Center for Neurologial and Behavioral Medicine, Ltd.) Dr. Hirsch has nothing to disclose.