Status
Not open for further replies.

edspec77

New member
Joined
Oct 11, 2009
Messages
7
Reason
Learn about ALS
Country
US
State
TX
City
San Antonio
I apologize in advance for my ignorance about this subject. I need a little feedback about my EMG's.
Quick overview...onset of symptoms was in October 2009 following a bad GI virus. My symptoms progressed quickly (literally spread through body in 1-2 weeks) impacting almost every limb....both hands, arms, and right leg and foot were mostly affected. In addition to the weakness (which doc's say is not clinical, but instead muscle fatigue), I have had random twitches throughout the entire body since the onset....noticeably more in my problematic right foot and leg.

First appointment with neuro in Oct. one week into symptoms....he was worried about Guillan Barre, so he did a full nerve conduction study...all fine. He did an EMG...but only stuck the needle in a few locations in my right leg....all normal, so he said he didn't want to do anymore. He specializes in EMG's. Diagnosis: Post-viral Fatigue.

One month follow-up in November....he was still concerned about an atypical Guillan Barre, so he repeated the Nerve Conduction Study....all normal. I was concerned about MND and all the issues with my hands, so he stuck the needle in multiple places in my right arm and hand....all normal; again, he said there was no reason to do anymore. Diagnosis: Post-Viral Fatigue

Symptoms continued (did not progress, but did not resolve) with very little direction for physicians as to prognosis. With the encouragement of my family, I spent a week at the Mayo Clinic in Rochester, MN for a battery of exams and tests during mid Jan 2010. My overseeing physician was a neurologist, so he repeated all of the exams, MRI's, and EMG's. All normal. This time the EMG was very thorough (head to toe on right side) and done by a doctor at Mayo that does EMG's all day long, so I was pretty confident in the results.

Here is my question....I was so confident after Mayo and the EMG results, that I really just ignored the fact that I was still twitching. That foot buzzes like crazy, too. Mayo sent me the 50 page report from my visit and I just pulled it out to discover that apparently she did not even stick the needle in my foot. I thought she had, but the report shows the following muscle groups being tested:
R. deltoid
R. First Dorsal Interosseous
R. Triceps Brachii
R. Tensor fascia latae
R. Tibialis Anterior
R. Vastus Medialis
R. Masseter

The top of the page has the following categories: Insert Activity (Normal for all), Spontaneous Fib (Normal for All), Spontaneous Fasc (Normal for All), MUP Normal (Normal for All). There are other categories like recruitment, duration, amplitude, and phases....but there is nothing under any of those areas.

Here are my questions:
1.I assumed those additional categories had nothing b/c all my other stuff was normal? I am so ignorant about this stuff and the EMG doc and neuro did not explain.
2.Would ALS be detectable with that type of EMG in those locations? They said they were specifically looking at the neuro muscular junction....is that different than looking at the integrity of the muscle. Again.....I'm so ignorant, so forgive me b/c I know this question sounds odd.
3.I remember her sticking the needle in more locations than listed on the report (like eyebrow, etc), so I was surprised only the seven areas were on the report. Is that common just to report general areas?
4.My symptoms had been going on for several months before the Mayo EMG...so I had assumed if MND was present in any capacity, the EMG would have picked it up. Now, I'm a little concerned that the foot with the issue wasn't actually tested. Would issues have been detectable in the other muscle groups....again, I felt she was being pretty darn thorough, but don't know too much about this stuff.

Overall, I've been getting so much better since January and can even run again (around an hour a day) w/ no issues with that foot or leg while running. There are still times throughout the day where that foot and leg still feel odd...and it still twitches and buzzes a lot. I had really convinced myself that it was no big deal and the fact that I was 8 months out and it was still going strong (no progression, no foot drop) met that this truly was just a Post-Viral that will continue to resolve. I'm still thinking that, but wondering if I need to request an EMG specifically for that foot.

Clinical exam of that foot (and all other limbs) by all neuros is 5+ on strength, absent babinski, 2+ reflexes, can heal and toe walk with ease, and can balance on that foot with ease.

My apologies for the very long post. Any insight is greatly appreciated.
 
Answers to your questions:

Rarely is the foot EMG'd because of the wear-and-tear those muscles take. More often it is the muscles of the lower leg (that control the foot) that are EMG'd to determine dysfunction . . . so . . . those areas should be sufficient. Your Mayo Clinic neuro knows what she is doing . . . I assure you.

1) The values that you said were left blank, were left blank because all of the other variables were normal.

2) The type of EMG that looks at the neuromuscular junction is a single-fiber EMG and not the standard EMG that most everyone gets. If you were given the same type of EMG that you had gotten in your previous two EMG's, then I feel you must have misunderstood what the neuro said to you about what it was detecting. Furthermore, although single-fiber EMG's can certainly detect denervation (and therefore lower motor neuron problems), it is used more to determine if someone has myasthenia gravis, where the problem is at the neuromuscular junction. ALS is a denervating problem and Guillan Barre is a demyelinating disease and has nothing to do with the neuromuscular junction.

3) Having said what I said in answer "2" . . . if they were EMG'ing muscles around your eyebrow, they might very well have been giving you a single-fiber EMG to detect myasthenia gravis. The other possibility is that they did both a single-fiber EMG and a standard EMG . . . and that the "other" places they EMG'd, were those of the single-fiber EMG. Therefore, what is on that report, are data from the standard EMG and not the single-fiber EMG.

4) If your symptoms were going on months prior to the EMG . . . and those symptoms were due to lower motor neuron dysfunction from ALS . . . the EMG would have detected it.

You have also shared with us that you are not only NOT progressing . . . but you are also getting better. That is not how ALS works. You got your diagnosis, so be happy with it, because it is treatable and actually doesn't even really need treatment, because the body will most often heal from such things. You just have to be patient.

I hope that helps.
 
Thanks for the reply. You provided a lot of clarification. Although the neuro doing the EMG at Mayo said nothing during the exam, I do remember her doing something different (switching to a different screen) when she did the eyebrow. Anyhow, when the other neuro at Mayo gave me my final diagnosis of post-viral, he did not go into the specifics, but made the statement that he was thorough and although he did not think it was a possibility, they did check for and ruled out MND, so that made me think that was incorporated into the EMG that he had done. Would they record the single-fiber EMG results the same way with the same categories: Insert Activity (Normal for all), Spontaneous Fib (Normal for All), Spontaneous Fasc (Normal for All), MUP Normal (Normal for All).

I guess I really don't know the difference between they types of EMG, so I assumed it was the same as what I had gotten from my local neuro. The first time my local neuro did the EMG, all he said was...."lets look at the integrity of the muscles"...never really further explaining. The next time he did it was at my specific request b/c I was concerned about ALS, so I'm pretty sure he did the standard EMG. As he was doing it, he talked my husband and I through the process.

Anyhow...yikes...a little worried now; I was so confident that my EMG's were looking specifically for denervation. I guess my next question would be, how can I tell which type she was doing? On the report, the section just reads: Motor Unit Potential (I think...it's not in front of me right now). Would she have used different types of needles, inserted the needle differently, etc. I just know so little about this; perhaps I need to call my neuro at Mayo and further inquire.

Thanks.
 
There is nothing to "yikes" about . . . I assure you. They did both at Mayo and the two previous EMG's that you got were the standard EMG's that would most certainly detect any problems with nerves and/or muscles.

As I said: You got your diagnosis and go enjoy your life.
 
Thanks Wright. I had actually called Mayo (instead of speculating, I thought I’d just check). Of course, I wasn’t allowed to speak with the doc (which I didn’t expect), but his admin said that she orders all of the EMG’s, and she looked in the system to see what she ordered and it was just a normal adult EMG....in her words “the order says nothing about a small fiber EMG, but it is possible that the doctor did one anyways.” I think they did a single fiber EMG, possibly in addition to the standard EMG, b/c in her notes above the results it says….there is no evidence of an issue at the neuromuscular junction or any type of myopathic process. She also indicated that all muscles tested with the needle EMG were normal. So, to me, it sound like she did both….but then again, what do I know! Wright you mentioned that the SFEMG would still detect denervation, and I actually read several studies where the SFEMG was used to look at the progression of ALS. I also went back and looked at the paperwork from my leg EMG (Oct) and arm EMG (Nov), both of which were standard (not SFEMG), and the doc was actually very thorough in each location….5 needles in each, so that made me feel good, as both of those have been problem areas since the onset.
 
Status
Not open for further replies.
Back
Top