Help With Emg Results

[KANSASTOM]

I am trying to understand what these results mean, I am getting two conflicting opions from two Dr's. My nerve conduction velocities are pretty much normal everywhere but my left calf, where the atrophy is located. The EMG portion revealed occassional positive sharp waves and fibrillation potentials pretty much everywhere. On the other hand I had no fasciculations, normal motor units, normal recruitment and normal interference pattern everywhere. What does this mean? Is there another name for the SNAP is it the H or F velocities and what would be a normal speed. Thanks in advance for any help.

[crystalkk]

Tom,

Who is the other dr, besides the nuero and what is he telling you? When you say postive sharp waves and fibrillation potentials pretty much everywhere, what muscles besides lower leg?
Are they distal muscles in the upper area?

[KANSASTOM]

This is the report from the Physiatrist. The upper muscles include the abductor pollicis brevis and pronator teres, brachioradialis, triceps and biceps. The first dorsal interosseus and deltoid were silent and normal motor units with normal recruitment and full interference pattern.

[KANSASTOM]

Oh the other Dr is the neurologists who said I had ALS and the physiatrists said there isn't enough evidence to make that diagnosis since I have no upper motor neuron signs.

[crystalkk]

Tom,

In the muscle that showed fibs and sharp waves how was the motor units, recruitment and interference pattern? Was that all normal as well?

[KANSASTOM]

Yes they were all normal in all of my muscles except for the PSW's and the fibs. What does insertion activity mean?

[crystalkk]

It's when they they stick the needle in the muscle ....it is noisy at first but then you here silence....
if it is increased it stays noisy the whole time....That's the only way I can explain it.

Tom, like i said I am not a dr, but I definately agree that general nuero gave you the ALS dx way to fast.
It could be numerous things including MMN which is treatable, If I where you I would get that referal to
the specialist.

Do you remember how your reflexes were......normal, diminished, or absent.

[wright]

Hello Tom

I was just reading your posts and I think that your neuro was a little premature to diagnose with ALS, especially given the fact that you don't have any upper motor neuron signs. He might be diagnosing you with progressive muscular atrophy (PMA) but I think that would be premature also.

I'm not going to sit here and tell you that you don't have PMA but other things have to be investigated. The fact that you have PSW's and fibs in muscles of your calf and triceps and biceps and forearm (brachioradialis and pronator teres) and hand (abductor pollicis brevis) says that you are denervating. The muscles that are denervating in your arm are from a few different nerves and so could point to some type of mononeuropathy multiplex and multifocal motor neuropathy would be a possibility (it is treatable by the way). Your condition could also be autoimmune in nature.

The decreased SNAP in your calf would tend to point away from PMA but a small percentage of PALS do have lowered SNAPS (the odds are on your side, though).

You don't have any increased MUP's and you have normal recruitment patterns. Those are things that are typically seen with PMA, especally if you have atrophy. You could certainly be in the early stages of things, but too many things are not lining up. I think you also said that you don't have any muscle weakness: atrophy without muscle weakness is not PMA.

Bottom line: get another opinion from a neuromuscular specialist. I would be cautiously optimistic that it is something treatable, especially given the fact that your family has a similar condition.

[wright]

I was just looking at my last post and noticed a mistake (I guess I should proof read them before I hit the submit button).

You don't have any increased MUP's and you have normal recruitment patterns. Those are things that are typically seen with PMA, especally if you have atrophy.

What I should have said is that increased MUP's and REDUCED RECRUITMENT are what are seen with PMA, especially if you have atrophy.

Again, you don't have increased MUP amplitude and you have normal recruitment, which are good signs. It shows that you don't have chronic denervation.

Get that second opinion.

[awieleba]

you want to look at charcot-marie-tooth. it sounds like what you have. It has high arches, hammer toes, gait proplems etc etc. ANd can effect/atophy of hands. It can be inherited. Just somthing to check out on ninds! Ask your neuro about that, cant hurt-your father and grandfather have the same looking thing?

good luck!

april

[KANSASTOM]

Yes I have been thinking about CMT also, except I don't have any sensory abnormalities. I am now convinced the answer to my problems is to seek an expert's opion. I was under the impression neurologists were expert on ALS, but it turns out this isn't always true. I am going to push to go to the MDA clinic and maybe bring along my Dad, or maybe just pictures of his hands and feet. I am not going to put my Dad through any sort of testing he is 74 years old, and I don't want him to feel guilty if this really turns out to be some sort of hereditary disease.

[crystalkk]

Tom

Good luck with the MDA.

Hang in there,

[fiddleplayer51]

Tom,
Click on the Sticky by Al just above your post called "Read This about EMG & ALS". Open up the link in Al's post. You can download an EMG manual for a fee. I downloaded it when my PALS was being diagnosed and learned alot.
All the best,
Jane

[crystalkk]

Jane,

Where do you find the sticky? I heard people mention this before but I can't find it.

[fiddleplayer51]

Crystal,
On this page just above the dark blue strip that says: User CP Blogs FAQ Member's List Calendar New Posts etc., you'll see the title of this thread "Help With EMG Results" in bold black letters. Above that in light blue is the hyperlink: ALS/MND Support Group Forums > ALS and MND Support Group > Do I Have ALS? Is this ALS?

Click the "Do I Have ALS? Is this ALS?" portion of the hyperlink. It will take you to the list of threads. The second one in the list says: "Sticky: Read this about EMG & ALS".
Click on that Sticky and the first post is a post by Al which contains a link to the EMG site.

Good luck!
Jane

[crystalkk]

Jane,

Thank You!

[fiddleplayer51]

Crystal,
Glad you found it. ;-)
Take care.

Jane

[KANSASTOM]

Do you remember how your reflexes were......normal, diminished, or absent.

I just read the report again and regarding my reflexes they were 2/4 at both knees and 2/4 at the right ankle and 0/4 at the left ankle. No clonus and the plantar response is downgoing bilaterally and symmetrically. I think that is the Babinski test. I believe this means the reflexs were diminished. Not sure if that means anything.

[crystalkk]

Tom,

The left ankle is absent. The right ankle and knees are normal. Is the left side the side you have the Atrophy on. Did you get referral and make appointment with MDA.

[KANSASTOM]

Yes the left side is where the atrophy is located. I do have an appointment with a ALS specialist with the MDA clinic on Aug 22nd. I have alot of questions for him.

[crystalkk]

Good luck, keep us posted.