EMG question, please, TY

[joebing]

Hi,

I was sitting wondering if its possible for the neurologist to put the needle in the wrong spot & get a false negative?

How do they know which muscles to put the needle in?

My Dr put a needle in my big toe & two in the calf?

Thankyou for your answers as theyve been most helpful.

Joe

 

[Moonmark]

Hi Joe,

I am not a medical professional, but I assume you had your EMG conducted by a neurologist. I see you are in Boston-- what hospital were you seen at and what neuro did the EMG?

from what I have read here, the EMG often picks up abnormalities even before symptoms may be evident, so if you had your EMG done by a neuro, who is highly trained, especially if they are a specialist in neuromuscular disease, then you probably don't have to worry about whether they missed something or which muscles they poked.

Sandra

 

[halfin]

Yes, I have wondered about this somewhat myself. I think as Sandra said that ultimately you have to rely on the training of the neurologist. I assume they are not taught just to stick the needles in at random. There are certain patterns of symptoms that would lead them to investigate certain locations. For cases where there is weakness then of course they would investigate the muscles that seem to be weak. If there are more general symptoms then I imagine they would perhaps do a set of locations just to see if anything might be going on. Depending on how likely the doctor thinks a neuro-muscular problem is, that would probably control how intensively they probe the muscles.

I actually saw the neurologist the year before my ALS diagnosis, for an unrelated problem. I had some numbness in my left thumb tip and shooting pains through my left shoulder. It turned out to be arthritis in my neck vertebra putting pressure on the nerve. But as part of the testing, he did do an EMG in my left arm (which was clean). So for this instance he only investigated the one limb because that was where my problems were. When I came the following year with bulbar symptoms, he did a very thorough EMG that involved all four limbs and took a long time, and found scattered problems. So it all depends on the clinical picture, and what direction the doctor thinks needs to be pursued in the testing.

 

[marywest45]

Hal,
You mentioned that you came in with bulbar symptoms and had EMG done on all 4 limbs. What about EMG in bulbar region: tongue, face?
From what I understand, every ALS center have their own "golden standard" on performing EMG... For example my doctor does 2 limbs and 2 spine (paraspinal regions); some other centers do all 4 limbs and tongue.
Mary.

 

[joebing]

Thankyou Sandra & Hal,

Sandra, I had it done in an office, not a hospital but the Dr was a neuromuscular neurologist.

Im sure he stuck me in my big toe, twice in the calf & my wife is saying one in the foot. I dont remember that.

Hal, Im not very much into the emgs & I dont know much but from reading here, I've read that emg will pick up dying nerves even before weakness is noted by the patient.

Makes one wonder why something didnt show on yours.

Thankyou both,
Hoping you are doing the best you can,

Joe

 

[Twinsmom]

My husband has had the joy of 3 EMG/NCT tests in the last 8 months...The first the most extensive with over 30 sites. The way the neurologist explained it, he kept testing more areas, as he continued to find damage in so many regions. HOWEVER, my husband is not diagnosed with ALS at this point. He has "Unspecified MND"...which is basically the catch all bucket for trying to find something other than ALS. Now that they have the baseline, the last 2 have been in more targeted regions, where we are looking at the limbs that seem to be getting weaker.

Our neurologist has said, that varying test results can be attributed to the tester. Meaning, there is a suggestive component-technique and equipment from one specialist to the next. We, of course had them done by 3 different specialists at the time, because our doctor wanted additional opinions. We are now sticking to one specialist so we can more effectively track change/progression.

Hope that helps a bit!

Peace,

 

[irismarie]

having another on 7th April. Will ask the question and take care to remark the placing.

 

[SilverLining]

IrisMarie, Good Luck on your next emg! I will say a prayer, I always pray for all of you pals anyway.

Why do so many people get repeat emg's if a negative means no als?

 

[halfin]

Mary, neither of the EMGs I had included the bulbar region. I asked the second neurologist about it and he said that he did not find bulbar EMGs to be reliable or informative. My second EMG was at UCLA and I think it was as you described, two limbs and a couple of spinal regions. My local neurologist had done all 4 limbs.

Joe, that is an interesting point that my pre-ALS EMG in my left arm didn't show anything. All I can really say is that today, my left arm is the least affected of any of my limbs. Most of my progression since diagnosis has been in my legs, with my arms less affected and mostly on my right. My speech has gotten only a bit worse and I can still be well understood. Very strange given bulbar onset.

 

[rhythman]

I read that the als issues seen on emg are indicative of damage to anterior horn cells in the spinal cord. Supposedly, when they are damaged, there are noticeable changes to the emg of the muscles throughout the body, with certain anterior horn cells affecting certain somatic muscles.

If this is the case, wouldn't a good 'cross section' sample of muscles be what the neuro is checking? My neuro didn't ask where I was having the most trouble; he just selected 6-8 locations per side. I assumed that this is some sort of pre selected test of certain areas to check for damage to certain anterior horn cells. (Much like each of the tests during the clinical exam checks the 'health' of specific cervical nerves).

Does anyone know if the above is somewhat accurate?

 

[trfogey]

Why do so many people get repeat emg's if a negative means no als?

Some people start their MND journey with UMN damage symptoms only. Folks who are diagnosed with PLS may face several years of monitoring and testing to confirm that their PLS hasn't become ALS. That ongoing testing would be likely to include multiple EMGs.

 

[SilverLining]

Ty Trfogey,

That makes sense. THX for explaining!

 

[halfin]

Rhythman, what you said sounds right. The one thing I'd add is that the anterior horn cells are the same as the lower motor neurons that we often refer to. Two names for the same thing.

 

[handinhand]

When i had my first test, I lost count of all the spots . He started at the top and worked all the way down. It showed up just about everywhere. I started with Bulbar onset ,but i do know he found more areas then just my mouth,neck and shoulders. I could not feel anything going on at that time except in my mouth and neck area. Now I feel them alot in my arms and a little in legs once in a while. It has been a year and a half. Anyway that is the only one I ever had and my new Nero didn't want the test done again. He was sadisfied with the first test.. He did do other tests but not that one.. L

 

[rhythman]

Rhythman, what you said sounds right. The one thing I'd add is that the anterior horn cells are the same as the lower motor neurons that we often refer to. Two names for the same thing.

It seemed to make sense to me, a lay person, last Fall when I read it. You never know for sure because there is certainly a lot of misinformation online. I'm sure that there are people on these boards though who know more about emg, etc., than some doctors.

Good addition Hal...I have to watch the terminology I use.