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Differential diagnosis:
1) Carcinomatous neuropathy resembles MND.
2) Diabetic amyotrophy – Wasting of proximal muscles of lower limbs. This is correctable with proper control of diabetes.
3) Syphilitic amyotrophy – Wasting of muscles of the hands with UMN lesions of lower limbs.
4) Cervical cord compression occurring in tumors and cervical spondylosis- Wasting And spastic paralysis of lower limbs.   Sensory manifestations are also present.
5) Myopathies and chronic polymyositis – Presented as muscle wasting and atrophy. In these fasciculations are absent. Muscle biopsy is diagnostic. Muscle enzyme CPK is elevated. Myopathy will help to distinguish from MND.

Management:
At present, no treatment significantly arrests the progress of the disease.

Palliative measures includes:
1) Psychological supports
2) Physical supports with the help from occupational therapists, speech therapists and physiotherapists.
These measures are essentials to keep the patient’s quality of life as good as possible.
3) Mechanical aids like splints walking aids, wheelchairs and communication devices all helps to reduce the handicap.
4) Feeding by percutaneous gastrostomy may be necessary if bulbar palsy is marked.
5) Non invasive ventilatory support may help the distress from weak respiratory muscles.
6) In allopathic system, they use the drugs that modulate glutaminergic  system (Glutamate antagonists like riluzole ). And agents such as nerve growth factors.

Homoeopathic Management: - Similimum.
Therapeutics:
I. Repertory of William Boerick:
1) Nervous system, Bulbar paralysis: Guaco, Plumb. met, Mang.oxydatum.
2) Nervous system, Degeneration(softening, sclerosis):
  2+ - Aur.mur,Phos, Plumb.met.
  1+- Alum, Alum.sil, Arg.nit. Aur, Bar.mur, Carb.sulph, Naja, Oxalic.acid, Phos, Physostigma, Picric .acid.

II. Kent’s repertory:
1) Throat, swallowing, impossible, paralysis from:
  3+- Stram.
  2+- Alum, Alumn, Apis, Cocc, Gelse, Nat. mur, Nux Vom,Tab
2)Mouth, speech, wanting paralysis of organs from:
  3+- Caust.
  2+- Anac, Crot.c, Gelse, Glon, Mur.acid, Staph.
3) Mouth, speech difficult:
  3+- Bell, Crot.c, Gels, Lach, Nat.mur, Op, Stann.
4) Throat,liquids taken are forced in to nose:
  3+- Arum.t, Lach, Lyc
  2+- Bar. carb, Carb.ac, Cur,Nat.mur,Phyt,Plumb.
III. Rau’s special pathology:
  1) Paralysis of bulbar muscles: Caust, Hyos,Nux.vom,Cocc,Gels, Op,Plumb,Ruta
  2) Paralysis of face:Bell,Caust,Cocc, Graph, Nux vom
  3) Paralysis of tongue and organs of speech:Arn, Acon, Ars,Bar.carb, Bell, Caust, Cocc, Cupr, Dulc, Lach, Op, Mur.ac,   Plumb, Hyos,Stann.
IV. Boeninghausen’scharacteristicmateria medica and repertory:
1) Mouth, throat and gullet, paralysis of deglutition
  4+- Caust.
  3+- Cocc, Gels, Laur, Lach
2) Voice and speech, paralysis of vocal cord:
  4+- Cocc,Gels,
  3+- Caust, Hyos,Laur,Nux vom, Rhust, Stram.

Causticum: Paralysis of single parts- vocal organs, tongue, eyelids, face, bladder, extremities, generally of rt sided. Paralysis from exposure to cold wind or draft. Paralysis after typhoid, typhus or diphtheria;appearing. Drooping of eye lids,cannot keep them open. It is used in paralysis which is remote from apoplexy, the paralysis remaining after patient has recovered from apoplexy with inability to select proper words. Laryngeal muscles refuse their services, cannot speak a loud word. Aphonia. Sudden aphonia after taking cold. Paralysis of face or tongue or hemiplegia with giddiness, weakness of sight, weeping mood, hopelessnessand fear of death.

Guaco:-Acts on nervous system. Bulbar paralysis. Deafness. Tongue heavy and difficult to move. Spinal irritation.Spinal symptoms are most marked. Beer drinkers threatened with apoplexy. Larynx and trachea are constricted. Difficult deglutition. Paralysis of lower extremities.

Plumbum metalicum: Paralysis with atrophy. Muscular atrophy from sclerosis of spinal system. Excessive and rapid emaciation. General or partial paralysis with great weakness and anaemia. Clonic ortonic spasm from cerebral sclerosis or tumor. Paralysis of plumbum is prominently of spinal origin. Paralysis of upper extremities is more marked. Ptosis. Heavy tongue. Difficulty in articulation. Tremor of nasolabial muscles. Twitching of the side of the face. Paralysis of gullet and inability to swallow. Paralysis of lower extremities with paralysis of single muscle. Paralysis from over exertion.

Manganum oxydatum: Low monotonous voice. Economical speech. Mask like facies. Muscular twitching. Cramps in calves Stiff leg muscles. Occasional uncontrollable laughter. Peculiar slapping gait. Workers of manganum binoxide are frequently affected with bulbar paralysis. Pseudo sclerosis. Progressive lenticular degeneration. Similar symptoms to paralysis agitance.
Plumbum iodatum: Has been used empirically in various forms of paralysis. Sclerotic degeneration, especially of spinal cord. Atrophies.

Phosphorus: Paralysis from fatty degeneration of nerve cells. Progressive spinal paralysis. Ascending sensory and motor paralysis from ends of fingers and toes. Arms and hands become numb. Fingers feel like thumb.Can lie on right side. Post diphtheritic paralysis. Tottery gait Periodical contractions of fingers as from cramps.

Cocculus: Paralysis of facial nerve especially of one side. Or tongue pharynx. Paraplegia and rheumatic lamness in weakened or nervous subjects, who are inclined fainting fits and palpitation of the heart. Paralytic affection originates in the small of the back after taking cold, with cold feeling of extremities and edema of the feet. Paralysis after apoplexy. Paralysis of lower limbs. Paralytic immobility. One sided paralysis of the face with cramp like pain in masseter < opening the mouth. Prosopalgia. Tremor of lower jaw and chattering of teeth when attempting to speak. Lines of face are deepened as if drawn. Paralysis of the tongue with difficult speech. Pains at the base of the tongue when protruded. Paralysis of muscles of deglutition with difficulty to swallow.

Gelsemium: Complete motor paralysis, rather functional than organic in nature. Paralysis of occular muscles. Ptosis. Paretic condition of the tongue causes difficulty to speak. Speak is thick. Paralysis from emotions. Post diphtheritic paralysis. Paralysis of larynx causes aphonia. Locomotor ataxia. Paraplegia.

Aconitum nepellus: Facial paralysis accompanied with coldness from exposure to dry cold wind especially in acute cases. Paraplegia with tingling. Numbness of the affected parts.
Lachesis: Especially left side. Awkward. Stumbling gait. Paralysis after apoplexy. Trifacial neuralgia. Spasm of glottis.

Nux vomica: Incomplete paralysis of the face, arms, and legs with vertigo, weak memory, darkness before the eyes, ringing in ears, loss of appetite, burning in stomach, flatulence and vomiting after eating and drinking.Constipation especially in drunkards. Jaw contracted. Infra orbital neuralgia. Left angle of the mouth drops. Twitching and spasmodic distortion of face. Articulation and speech difficult. Paralysis of arms. Automatic motion of hand towards mouth.

Opium: Paralysis and insensibility after apoplexy, in drunkards, in old people, associated with retention of stool and urine. Spasmodic facial twitching, especially of corners of mouth. Hanging down of lower jaw. Distorted face. Twitching of facial muscles. Face covered with profuse sweat. Paralysed tongue which dry and black. Difficult articulation and swallowing. Tongue protrudes to right side. Inability to swallow. On swallowing food goes the wrong way or returns through nose. Painless paralysis. Twitching of limbs. Numbness. Jerks as if flexors are overacting. Sensation as if lower limbs were severed and belongs to someone else. Shifting and trembling gait. One or other arm moves convulsively to and fro. Coldness of extremities.

Stramonium: Paralysis after convulsion,. Paralysis of one or spasm of other side. Stammering speech. Cannot swallow on account of spasm.

Graphitis: Rheumatic, peripheric paralysis of face. Distortion of muscles of face and difficult speech. Sensation of cobweb over the face.

Belladona: Apoplexy , congestion of the head, paralysis of one and spasm of other side of the body, paralysis of the face and locomotor ataxia.

Arnica: Paralysis due to exudation within the brain or spine. Paralysis in consequence of apoplexy, of concussion, of weakening disease and of protracted intermittent fevers. Paralysis of face and lower lip hang down. Lower lip trembling while eating.

Conium: Paralysis from periphery upwards, of old women. Speech difficult from paralysis of tongue. Distortion of tongue and mouth. Food goes down the wrong way and stops while swallowing. Paralysis of lower limbs than of upper limbs. Staggering < turning the head or looking sideways.

Arsenicum album: Paralysis associated with great prostration and neuralgic pains. Spinal affection with gressus gallinaceus. Twitching of muscles of face. Paralysis and contraction of limbs.

Ruta graveolance: Facial paralysis after catching cold.

Baryta carbonicum: Causes paralysis by producing degeneration of the coats of the blood vessels. Facial paralysis. Paralysis of old people. Paralysis after apoplexy. Facial paralysis of young people where the tongue is implicated.

Natrum muriaticum: Paralysis from cold. Numbness. Tingling of tongue and lips. Loss of taste. Tongue striped along the edge. Numbness and stiffness ofone side of the tongue. Tongue heavy and difficult speech. Tongue feels dry but actually not dry. Uvula hangs to one side. Food goes down the wrong way. Post diphtheritic paralysis. Fluids can be swallowed. Paralytic condition of lower limbs.

Curare: It is a great remedy for paralysis of various kinds and of various parts of our body. General paralysis of motor system. Ptosis. Facial and buccal paralysis. Paralytic failure of power to swallow. Paralysis of deltoid muscles.

References:
1. Principles and practice of medicine– Davidson
2. Text book of medicine- K.V. Krishna Das
3. Disease of nervous system- Sir. Francis Walshe
4. Disease of nervous system- W.B.Mathews and Henry Miller.
5. Brain’s disease of the nervous system- Sir John Walton.
6. Harrison’s Principles of internal medicine
7. Repertory of William Boerick
8. Kent’s Repertory.
9. Boeninghausen’s Characteristics Materia Medica and Repertory.
10. Raue’s Special Pathology.

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