I thought EMG cant be clean with als, please help answer, Thanks

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joebing

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Hi,

Apparantly the link didnt go through, only as an error, I apologize.

I have copied & pasted the post

More confused than ever.....

--------------------------------------------------------------------------------

We got some unsettling news yesterday. Its actually a bit confusing. We went to new doctor who specializes in ALS. He was pretty adamant that Mike does not have PLS but is showing signs of ALS instead. Needless to say I was a bit stunned to hear this. His reasoning was that Mike is not as stiff as most people with PLS and there is significant muscle wasting and rapid progression which is not typical of PLS. He felt Mike was showing signs of upper and lower motor neuron disease.

Anyway, he sent Mike for another EMG and the EMG Tech said everything was fine (not indicative of ALS). However, we later met with the ALS Clinic just for introductions b/c we will now see this new doctor and the clinic every 4 months. They did a breathing test and his breathing is at FVC of less than 70%. The tech said this is at the lower end of breathing in the “mid-range”, and was not a good result. So now I don't know what to think. I don't know if we'll hear back from the doctor before our visit in August.

JustJ


Is this really possible?
Thx
 
Sometimes ALS starts in the upper motor neurons and only later progresses to involve the lower motor neurons too. In this case the emg will be clean at first. During this time there is no way to tell if the disease will stay in the UMNs, in which case it is called PLS, or progress to full blown ALS. However possibly a doctor, after seeing many cases of ALS and PLS over the years, will come to believe that he can predict which way certain patients will go. So he might tell someone with only UMN signs that he actually has ALS, even though there is no clinical evidence yet. Doctors often have high opinions of their own abilities. Whether he is right or not remains to be seen.

Statistically, many or most cases of PLS do eventually turn into ALS so the odds are in favor of his prediction. But it is questionable as a diagnosis.
 
Hi Halfin,

Thx for taking time to answer. I do appreciate that! My first thought was exactly what you wrote but then I read Abbaschild posting to Shizzy where she states her initial emg with lower motor symptoms presant was clean.....surprisingly at Hopkins. It wasnt until over a year later that the emg showed dirty. She said it was all lower motor neuron symptoms until about the time of her 2nd emg over a year later.

How can an emg miss that?

Im concerned, I have a footdrop, a clean emg & hey, Im wondering now.
Thanks
 
Joebing

AbbasChild never said that the first EMG was given when there were clear lower motor neuron symptoms . . . so please don't make statements when all of the facts aren't clear. It will undoubtedly cause panic on here.

I assure you, that if a competent neuro performs an EMG when there are clear lower motor neuron symptoms and the affected area is needled . . . and it is clean . . . then the symptoms aren't due to lower motor neuron dysfunction.

Furthermore, in the JustJ post, the "clean EMG" was stated by a tech and not a neuro and a tech has absolutely no business saying a thing about the exam. He/she should get in very big trouble for doing that. Furthermore, it's typical that techs do the NCV portion of an EMG and that the neuro does the EMG, so the tech might have been speaking about the NCV and not the EMG. Again, we clearly don't know the whole story . . . and to be honest . . . we hardly ever do when having information being relayed second or third hand by lay people.
 
Hello Wright,

Thank you, I was hoping someone would reply. I honestly dont mean to cause panic but Abbaschild did indeed say she had the emg done at the time of lower motor symptoms. She had footdrop in one foot & a DR perfomed the emg?

Geazz, I have a footdrop & a clean emg, that is my only reason for asking. Im trying to gather the facts not alter them, I hope you can understand,

Thanks for your help,

Joe


(From abbaschild)

shizzy, I had a clean emg the first time it was checked at Hopkins. About a year and a half later it proved dirty. I agree with helpinhand about having a good test. While I think my first doctor was good and there wasn't enough progression for MND to show, the second doctor was head of the department and very obviously good. In our little city locally an ALS Clinic just began in March. I would not go there for the testing even though they have the clinic. They haven't seen enough ALS yet.


My first problem was in one foot/leg, then the other, and from there worked upward. Definitely lower motor in the beginning, but upper was present at the time of the second emg.


Footdrop was my first problem, but progression was slow. It was only in the one leg at the time of my first emg. Many things can cause isolated weakness.
 
Hello Joebing

I would want to see that EMG because it could have been that there wasn't enough evidence at the time to give a diagnosis of ALS and so there might have been some misinterpretation of what the neuro actually said. Again, I don't trust what anyone has to say because most everyone on here does not have any type of medical background to fully understand things. It's nothing personal toward anyone; I just won't base my opinion on something controversial like that, unless I know all of the facts.

If you have footdrop and it is due to some kind of lower motor neuron problem . . . meaning that the motor neurons are dying and thus the muscles they are innervating are being denervated . . . the EMG will pick it up. There is no way that it can't unless it was done by an incompetent neuro and the appropriate muscles weren't needled. Furthermore, any type of denervating problem (i.e. peripheral nerve problem) or myopathy will be detected by the EMG.

I hope that helps. Take care and I wish you well.
 
Hello, I just wanted to be clear that only one leg was involved at the time of the first emg, and done by a doctor at Hopkins. Later they believed I had classic symptoms of Multi focal Motor Neuropathy. Begging your pardon for the confusion, I shoud not have said the first emg was clean, rather that the first emg did not cause ALS to be a concern. Peripheral nerve problem was questioned...

Joebing, glad you came to this page--Wright is more able to help than I. I hope you don't ever have a dirty emg! I also wish you well.
 
Wright, buddy thanks for jumping in, I appreciate all your feedback! Must get frustrating to repeat yourself. My apologies for even taking time up on the board. (You are right about not always knowing the entire story) Thank you for explaining your knowledge to me!

Abbas child, you're a sweet lady! Thanks for replying & helping me out too. Im trying to understand how/what can be causing this problem. Im sure anyone can understand why Id be happy to know I can rid the fear of als with the clean emg. Got a pit in my stomach when I read that your emg was clean with a footdrop.

I hope I didnt stir up anything & want to thank you both & halfin too, buddy! Thanks.

Joe
 
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