A Worried Friend, Could it be ALS?

[Xainsterr]

Hi all,

Hope most of you're having a good day unlike a friend of mine who is literally being eaten away from the fear of ALS. Hats off to those who have ALS disorder but fighting it everyday.

I'll try to keep it short. . . here it goes.

My friend started having weakness in his left thigh 2 months back, in a particular muscle followed by cramps almost after 7 days. While having cramps in the left thigh, he was feeling weakness in the right thigh as well. Now his whole left thigh is stiffed and he has difficulty in walking. He would walk few steps and wait for his muscles to catch up. Twitches were there and he recently started having fasiculation around his left knee.

Facts:

1. MRI of brain & spine is clean

2. CPK test is clean

3. ANA test is clean

4. CBC is clear.

His EMG report is not the same though. Polyphesia values are abnormal. Fasculations started 'after' the EMG report so there is no fasucaltions at the time when EMG was being conducted.

I've scanned the EMG report and put it up for you have a look at it -> EMG Report.zip

Would highly appreciate the feedback. Thank you for your time & patience for going through my post.

 

[limegreenphysicist]

Hi,

Sorry about your friends trouble. I looked at the NCS study and EMG. In the NCV study there is not mention of if your friend is male or female and he/she height weight and also no reference ranges for the conduction velocities that would depend on these things plus age. Did the neurologist give an opinion or write up to go along with this study?

I did not see one included which is always given with a study even an abnormal study.

Looking at the EMG suggest that your friend is reinnervating with some chronic denervation and lacking active denervation with the absence of fibrillation potentials and positive sharp waves. Without these two findings, I would find it a little questionable for a neurologist to give a diagnosis of ALS. Without information of the NCS normal ranges, I cannot comment further on the wide possibilities of diagnosis.

If you would be willing to provide us with the opinion or ranges for your friends NCS which should have been included then we would probably be able to have a clearer picture.

Also Wright is exceptional on reading NCS and EMG...I would definitely be interested in hearing his opinion. Has your friend been diagnosed with ALS based on this study?

Also what was the opinion of the clinical examination which is very important. Any signs of abnormal reflexes (loss or gain), jaw jerk, babinski, hoffman?

There is so much needed for an ALS diagnosis besides an EMG/NCS.

Thanks Kelly

 

[Xainsterr]

Thanks for your prompt response. I missed the first page of the report so I've uploaded the report again with all pages intact. I cannot find any page that would suggest that it contains reference values. My friend is around 90kg but frankly speaking I don't know how much exactly he weighs. He is around 5.8 feet tall.

EMG Report -> EMG Report.zip

I would ask my friend to take part in the discussion becasue it would be more helpful.

Thanks again!

 

[Xainsterr]

My friend has been to two neurologists and they are 'not' of opinion that he has ALS. Though they are unable to provide him with any reason regarding why is this happening. One of 'em simply said, "he does not have ALS", without even refering to EMG report. The second neurologist is not ruling out the possibility of ALS and ordered the above mentioned CPK, ANA & MRIs. His physical exam showed mild weakness in thighs and lower back where the spinal cord ends.

Thanks

 

[Xainsterr]

I missed out the first page of EMG report in my first post. Following contains all the pages of EMG report.

EMG Report.zip

Thanks!

 

[Xainsterr]

Urm posts with weblinks/ hyperlinks requires approval so I mistakenly posted two replies with same link. Missed one of the pages of EMG report in my first post so the new link would be visible as soon as the post is approved.

Regards!

 

[limegreenphysicist]

Even without the info on your friends NCS..I would agree that his EMG is not characteristic of ALS and would concur with his neurologist. The EMG findings could be a number of different things. ALS EMG would have to include acute/active denervation such as fibs and psws along with the large MUPs and reduced recruitment which is seen in renervation and being that your friend had multiple limbs tested with no evidence of fibs or psws in any of the limbs...he should definitely not worry about ALS. I'm no doctor or anything but well versed or aka paranoid researcher lol..keep us updated and I'm sure Wright will be on the thread soon to either agree or call BS on me lol..

 

[Xainsterr]

Thanks for your positive & encouraging reply, a bit relieved I must say. Today my friend is going to another neurologist so lets see what he has to say.

I'm also interested in what Wright has to say since you've mentioned him in both of your posts.