What does it all mean..

[wlmrfair]

I've posted before as I was under the care of a Nuero from Jan. - July. Was told the wasting in my thumb are on the right had not progressed. At that time I had twitching in the extremities more so on the right than the left. The twitching is continuing and appears to be getting worse in my right foot, particularly in the arch area and ankle. Following are some excerpts from the doctors initial finding in Jan and then late June. I'm not asking for a diagnosis, but can someone interpet what was found.

NCS denote moneropathy at least at the wrist with suppression of CMAP. Ulnar nerve unremarkable. F waves are both slowed for the median and ulnar nerve on the right. Sensory studies demonstrate the median neuropathy with similar ulnar slowing and suppression of SNAP. The radial nerve is slowed with suppression of SNAP as well. The dorsal ulnar cutaneous nerve on the right is minimally slowed.

EMG performed of the right D3 t0 D& paraspinal musculature and the right SCM both normal. The right tongue reveals some large motor units and decreased number. A study of the right and left deltoid, biceps, triceps, BR, ECR, EIP, FCU, first DI, OP, FPL, FCR, and FDP demonstrate right sided denervation abnormalities with a relatively normal left side. The abnormalities ave very prominent with a OP, FPL, FCU, first DI and EIP but largely spared teh other muscles and consistent with chronic denervation. No fasciculations are noted clinically or eletrodiagnostically.

So, here now, 10 months later, the twitching is increasing in my feet and lower legs, on the right more than the left. Also I have what I would call a "vibration" like feeling in my right side of my right knee.

Can anyone tell me in laymen terms what the nuero says in the above findings?:?:

 

[limegreenphysicist]

I'm confused about the right tongue? WTH?

 

[wlmrfair]

What does he mean "the righ tongue reveals large motor units and decreased numbers" ?

What do you mean WTH?

 

[limegreenphysicist]

This EMG write up is very confusing to me and would like to wait to see what Wright has to say on it before I sink my brain into it. It seems you have a lot of sensory impairment. What did the impression part say on your EmG write-up? And is there anything you left out from copying it that you felt was not important?

 

[wright]

Hello

I'll simply address your questions in more or less the order you posed them.

Suppression of CMAP (compound muscle action potential) means that there is loss of axons of a motor nerve (axons make-up nerves . . . think of a nerve as a rope and the individual fibers of that rope as axons). You don't indicate in what you wrote, what motor nerve that is.

Slowed F-waves of the motor portion of the median and ulnar nerves indicates that the myelin (the insulation around nerves) has been damaged. Damage to myelin slows-down electrical activity along nerves . . . thus, the slowed F-waves.

Slowed ulnar nerve conduction velocity means that again, myelin has been damaged . . . but what is different with this particular study . . . is that it's the sensory portion of the ulnar nerve. Furthermore, a decreased SNAP (sensory nerve action potential) indicates there is a loss of axons of the sensory portion of the ulnar nerve. The same findings were shown with the radial nerve.

Your right tongue shows large motor units, meaning that there was reinnervation of the right side of your tongue (the tongue is innervated by both the right side of the brainstem and left side of the brainstem . . . just as you have right arm muscles and left arm muscles that are innervated by right-sided nerves and left-sided nerves). Reinnervation means that there was damage to those right-sided nerves (i.e. denervation) that subsequently healed. There was no mention of active denervation of your tongue.

BR = brachioradialis; ECR = extensor carpi radialis; EIP = extensor indicis pollicis; first DI = first dorsal interroseus; OP = opponens pollicis; FPL = flexor pollicis longus; FCR = flexor carpi radialis; FDP - flexor digitorum profundus

The first DI and OP muscles are muscles of your hand. All of the rest are muscles of your forearm.

I can't comment on what the EMG said because your wording was too vague: "Right sided denervation abnormalities" just isn't clear enough for me to make a comment (it can mean a lot of different things). I would suggest you talk to your neuro about it. I'm quite surprised he didn't discuss it with you already.

I hope that helps. Take care.


P.S. I guess I should give you the "big picture" as it pertains to ALS, since you are here on an ALS forum. You have denervation of multiple muscles of your right forearm and hand (no other muscles have been affected according to what you have shared). That can be caused by a lot of different things. You have damage to myelin, which points away from ALS (although myelin damage is seen in later stages of ALS, but you're obviously not in the later stages of ALS). You also have damage to your sensory nerves, which points away from ALS.