48yr M with Chronic progressive B/L UL weakness ( Rt > Lt )pure motor LMN + UMN Syndrome ? Probable ALS ( MND )

ALS
1st dorsal Interossei & thenar wasting present Rt > Lt
Patient has lost to follow up & Consulted a Neurologist at Bangalore where following evaluation is done 


Nerve biopsy report:-
Treating neuro physician suggested cellcept instead of Riluzole ( prone to have vomiting, dizziness)
But patient condition didn't improve  & Neurophysician suggested IVIG for which he visited again to SSIMS.

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