Emg Question/Clarification

[royalblaze]

Hello sorry to bother, I am posting my emg results the ncs portion was all normal. I haven't gotten to go over results with neurologist yet appt is months away the emg was done at a sport and spine rehab. I have no clinical weakness. Major symptoms are are 24/7 calf and foot fasciculations(also pre cramping feeling) and twitches randomly in other parts of the body. Any information would be greatly appreciated.

 

[ShiftKicker]

Hi there-

Please read the Read Before Posting link to learn why twitching absent any symptoms of ALS means the twitching is caused by something else. EMG reports come with a conclusion from the person conducting the test. What did it say?

 

[royalblaze]

IMPRESSION:
Abnormal study.
Electrodiagnostic testing of bilateral lower extremities was completed today. Motor and sensory nerve
conduction studies were within normal limits. Electromyography of the left lower extremity was within
normal limits. Electromyography of the right lower extremity revealed motor unit abnormalities which could
correlate with chronic right lumbosacral radiculopathy at the L2-S1 levels without evidence of active
denervation, although recent MRI lumbar spine completed on 11/3/23 did not reveal any nerve root
compression. Given these electrodiagnostic findings as well as patient's clinical presentation
(fasciculations and muscle cramping without any significant associated sensory symptoms/pain) in
conjunction with physical exam findings (hyperreflexia and clonus), there is concern for motor neuron
disease.

 

[ShiftKicker]

Thanks for posting the summary. It provides a bit more information about additional symptoms as well and helps give a better picture for people who might wish to provide insight here.

 

[lgelb]

There is no acute denervation, a diagnostic criterion in ALS. So it is more likely that you have something chronic going on, possibly in the lower spinal/butt nerves as stated, that is affecting your R leg. I would look closely at how you sit, how well seating is supporting you, and make sure you are keeping a neutral spine as much as possible.

Do you spend a lot of time in a car or in public transit, or while working sitting down? If so, you might want to try a new chair (like an "active sitting" type) or firm-but-not-hard cushion, even if you don't feel pain at the time. If you're not getting enough refreshing sleep, now would be the time to get that going, too.

In what limb(s) were the clonus/hyperreflexia found?

The format of this report suggests that a neurologist at a neuromuscular center (which is where you should go) may want their own EMG. I can see why you're concerned about the report. But the odds against ALS are still in your favor.

 

[royalblaze]

Thank you for your response, it is greatly appreciated. I stand 8-12 hours a day at work but the last 5 months I have been out of work pretty much sitting in a recliner most of day. ( out of work due to dizziness issues related to neck which PT has helped with) Back to work next week.

As far as the reflexes and clonus the exam results are as follows.

Patient seated comfortably on examination table. No significant muscle wasting noted throughout bilateral
lower extremities. No visible tremors or fasciculations appreciated in the upper or lower extremities.
Strength 5/5 bilateral hip flexion, knee extension, dorsiflexion, EHL, plantar flexion. Sensation intact and
symmetrical to light touch throughout bilateral lower extremities. Reflexes 3+ with hyperreflexia
appreciated of bilateral quadriceps and achilles. 3-4 beats of clonus bilaterally. Negative Hoffman sign
bilaterally and negative Babinski bilaterally.

The emg results (left leg was all normal)

EMG:

Muscles Were Studied in the Right Leg Including: Right rectus femoris, vastus medialis, anterior tibialis,
medial gastrocnemius, and short head of the biceps femoris.

Lumbar Paraspinals on the right were studied at the following bony levels: L3/4

Needle EMG study showed no abnormal spontaneous activity such as positive waves or fibrillation
potentials.

Motor unit abnormalities were seen in the right rectus femoris, vastus medialis, anterior tibialis, and
medial gastrocnemius muscles consisting of increased amplitude, increased duration, and reduced
recruitment. Other muscles showed no significant abnormalities.

Thank you again for any and all information is greatly appreciated, and my apologies again for taking up anyone’s time.

 

[lgelb]

Sitting in a recliner all day after being in a job standing all shift could certainly take a toll.

When you go back to work, I would try to stand on a shock-absorbing surface or wear shock-absorbing insoles in your shoes (a podiatrist can recommend the best ones for your particular surface) and consider shoes recommended for peripheral neuropathies. No matter why your nerves/muscles are jumpy, irritating them less can't but help.

 

[royalblaze]

Thanks again for the great info will ensure I take those steps. Does the bilateral clonus and reflexes point away from als? Sorry for the questions doctor just freaked me out, I had previously had two clean neuro exams, when trying to identify the dizziness cause. I also had previous reflex test by chiropractor, ENT, primary, and two neurologists who mentioned no concern for reflexes or weakness etc.

 

[ShiftKicker]

Yes, that's true. As well the dizziness. It sounds like you aren't including the entire picture here, as you've added a fair amount of info since your first post. With what you've already added, your symptoms point away from ALS.

 

[lgelb]

A few beats of clonus are not important so I wouldn't worry on that account. Chiros can be helpful but can also make certain conditions worse. I would be cautious about going back.

If a cause was never identified for the dizziness, against two clean neuro exams, apart from reflexes and some chronic nerve damage that has nothing to do with dizziness, this makes me wonder about systemic causes and how much lab work you had done at the beginning of all this. At a minimum I would have wanted a CBC, metabolic panel, thyroid panel, things like that. If those aren't in your records, I'd go back to your PCP and discuss.

 

[royalblaze]

Just wanted to provide an update, still no diagnoses on health issues but had an updated emg at neurologist today. They stated no signs of any MND. Did see fasciculation on emg but stated the pattern was benign. Just wanted to update in case anyone else came across the same results on Emg. Wish you all well, and my apologies for taking up your precious time.