Last post went to moderation. Hopefully this one will not. Anyway learn the difference between El escorial criteria vs awaji criteria.
Read # 3 below closely Patricia was Bulbar onset and one of the people who originally had a clean emg.
"3. Conclusions of the consensus conference
1. We reaffirm the general principles underlying the El
Escorial and Airlie House recommendations for the
diagnosis of ALS. These are set out in modified form
in Table 2. In particular, the importance of full nerve
conduction studies and conventional EMG in excluding
other diseases was recognised (Lambert, 1969; Behnia
and Kelly, 1991; Daube, 2000). It is important to keep
in mind that the clinical neurophysiological examination
is used in the diagnosis of ALS when the diagnosis is suspected
clinically – suggestive neurophysiological findings
are therefore not intended to stand alone, outside the
context of the clinical assessment.
2. We conclude that, since needle EMG is essentially an
extension of the clinical examination in detecting features
of denervation and reinnervation, the finding of
neurogenic EMG changes in a muscle should have the
same diagnostic significance as clinical features of neurogenic
change in an individual muscle. Thus, within a single
limb, we recommend that abnormalities required for
the diagnosis of ALS may be derived from either clinical
or neurophysiological study, thus constituting the
requirement for involved muscles as set out in the general
instructions (Table 2). This interpretation renders
redundant the category ‘‘Laboratory Supported Probable
ALS’’ (Table 2) and will facilitate earlier diagnosis since it will allow a limb to be classified as abnormal earlier
than if this decision is based on clinical or EMG criteria
alone. The essential change is thus to recognise a
neurogenic EMG abnormality (Table 1) as of equivalent
significance to the clinical abnormality. It is, nonetheless,
important to confirm that EMG evidence of neurogenic
abnormality is found in clinically weak muscles.
3. We recognise that muscles may show evidence of chronic
neurogenic change in the absence of fibs-sw. We therefore
propose that the presence of fasciculation potentials
(FPs) in a muscle identified as showing needle EMG features
of neurogenic change should serve as evidence of
ongoing denervation, equivalent in importance to fibssw.
This criterion would obviate the need for the often
difficult search for fibs-sw in patients with clinically evident
features of ALS; in particular, in cranial-innervated
muscles and muscles of normal bulk and strength. For
example, although Finsterer et al. (1998) recorded fibssw
in some patients in bulbar muscles, de Carvalho
et al. (1999) found no fibs-sw in bulbar muscles in 15
bulbar-onset patients; fibs-sw were found in limb muscle
in only 7 of these 15 patients. In addition, in 2 of 28
newly diagnosed upper limb onset ALS patients, fibssw
were absent in the weak upper limb."