Help Interpreting EMG Please

[JM888]

Hi Everyone

Thanks In advance for taking the time to read my post. I'm (35M) currently very concerned I have ALS after close to 3 months of severe progressive weakness, atrophy (confirmed by gp and neuro) and fasciculations in both legs and my right arm (i have a mobility scooter as cant walk more than 100m, and my right hand is very weak but still no "clinical weakness" apparently). I've also lost 10% of my body weight in 4 or so months with no diet changes. My first Neuro refused me an EMG 2 months ago and also refused to see me again before 6 months had passed (long story, but he tried to tell me it was all anxiety driven, my GP and the second neuro couldn't believe his attitude) so I was forced to book with another neuro for an EMG which was this morning.

The neuro completing the test has told me that ALS isn't even on his radar (his leaning towards post viral illness or an auto immune issue due to some sensory issues in the nerve conduction study that apparently point him away from ALS) and that nothing in the EMG raised red flags for ALS. My question is isn't it pretty clear from the attached EMG that ALS is very much on the radar with fasciculations (acute) and large motor units (chronic) noted in 2 leg muscles? He only mentioned chronic denervation and that he thinks there is another cause for my problems (I do have some lower back issues evident on recent mri but wouldn't explain my arm weakness)?

Cheers

 

[Nikki J]

No. There is a saying it isn’t so much the fasciculations but the company they keep meaning other findings are more important. There also are different kinds of fasciculations seen on emg. There is something called a fasciculation potential that can be benign or suspicious and look different on emg Your doctor who is an educated expert did not find what they saw on emg worrisome. Added to that your findings are localized whereas ALS causes widespread emg changes.

It sounds like your doctor is appropriately pursuing your symptoms and based on this result they have narrowed your differential. You are lucky autoimmune issues are usually treatable and post viral syndromes usually get better eventually

 

[JM888]

Thankyou, appreciate it. I've got trust issues with our system over here in Australia - I can't see this neurologist again, he only performs EMGs and completes a report before referring you to another neurologist if necessary (he hasn't deemed that necessary yet). Lead times to get in to a neuro are about 6 months here at the moment, so its worrying if you don't get answers and symptoms progress - It only took me 3 months to go from fully fit to needing a mobility scooter so not sure what condition I'll be in if I do have to wait 6 more months for another appointment, but can only stay hopeful and try not to stress about it .
Thanks again.