You report, “The NCS was normal in upper and lower extremities.” An abnormal NCS study could show (1) slow velocities (which would signify probable demyelination of the nerve axons) or (2) normal velocities and low amplitudes (which would point toward damage to the axon itself). Remember that the lower motor neuron (also, anterior horn cell) is in the spinal cord and sends one axon out to the muscle it innervates; the axon is covered with myelin, sort of like insulation around a wire.
A finding of “normal” indicates to this non-doctor that the problem is not in the axon and myelin—and that is why the “House team” could rule out neuropathies. So the problem is most likely in the lower motor neurons (in the spinal cord) or the upper motor neurons (in the brain). Lower motor neuron symptoms include atrophy, weakness, fasciculation, fibrillations,
hypotonia and
hyporeflexia. Upper motor neuron signs include
hypertonia,
hyperreflexia, clonus, spasticity and Babinski sign.
Remember that muscles work in pairs. As an example, the biceps pull your elbow in and your triceps push your elbow out. When your brain tells your biceps to contract, a simultaneous order tells your triceps (the antagonist muscle) to relax. In spasticity, the triceps don’t get the message. Or you can tell your foot to lift up, but the antagonist muscle keeps pushing it down. You tell your fist to open, the antagonist muscles tell it to stay closed. Or, as your PT said, “If his flexors are contracting, the extensors should be relaxing and his are not. They are all firing at the same time.” As you noted earlier, “his lower reflexes are 4+.” So the spasticity and hyperreflexia both point to an upper motor neuron problem.
Next, the EMG report you quote said there was no widespread deneravation and no fasiculations reported on EMG. As stated at
The basics of electromyography -- Mills 76 (suppl 2): ii32 -- Journal of Neurology, Neurosurgery & Psychiatry, “EMG is an obligatory investigation in motor neurone disease to demonstrate the
widespread denervation and fasciculation required for secure diagnosis.”
So, at this point—and in my non-doctor opinion--your husband is showing definite upper motor neuron signs, but the lack of widespread denervation and fasciculations (plus the pain) seem to point away from motor neuron disease. So that may be the good news while the bad news is nobody yet can figure out what it is.
Do your neuros have any idea of what they are looking at? (And, by the way, how old is your husband?)
In the meantime, try to be patient, stick with the PT, follow his safety instructions, and good luck!