Not sure what's going on

[ShadowJason]

So im a 38 yr old male, about a month ago I noticed Fasiculations in both calves pretty much non-stop. Along with random twitching everywhere else. I was also getting diffuse mild cramping all over pretty much constant. So I go to my doctor and she gets me all freaked out. So I go to a Nurologist and he performs a evaluation which was pretty much normal. There was a slight diffrence in reflexes 2+ in arms and ankles and 3+ in both knee's. I guess thats normal. So I get a EMG from this guy who is a ElectroDiagnostic Nurologist. And the results were abnormal.

Most of the muscles showed increased insertional activity, Fibs, Positive waves, and Fasiculations. The NCS was normal except Left Sural Anti Sensory Nerve showed prolonged distal peak latency.

The exam Impression was written as follows:

Diffusely increased Muscle membrane irritability without signs of chronic Axonal loss. All motor units appeared normal in amplitude, duration, and recruitment.

Normal motor and sensory responses in left arm and leg. He check the right leg as well and it showed the same stuff as the left.

He said he does not think its a MND and wanted a muscle biopsy. But you know how it goes, you always wonder if the guy knows what he is talking about. He could not give me a diagnosis at the time. So I am pretty much freaked out. I dont know what all this means other than the motor units appeared normal which I think does not suggest ALS?

Oh and I dont have clinical weakness or Atrophy, at least not yet.

Thanks for any input!

 

[glupavomomiche]

You are correct... With the normal amplitude, duration, and recruitment, ALS is not in the picture. However, something is definitely wrong! I know it's hard, but hang in there. It sounds like your do ct or knows his stuff and is exploring all possibilities before giving you a diagnosis. Please keep us posted... I'm curious to know what the final result will be!

 

[ShadowJason]

Thanks for the reply Sarah!

I am sorry to see you have this terrible disease, I am not a religious person but my thoughts will be with you. I have to wonder with my situation how much the mind comes into play, and if the mind could create pathology on such a fine level as a EMG. The reason I mention this is because I have been under terrible stress the last year. The majority of the stress resulted from getting hurt at work "seriously" and then have them get rid of me, and then dealing with Comp and financial issues. And then this pops up........Just a thought cause the timing. Because of this I only have Emergency Insurance but despite this I will have the biopsy. I was told that it takes a Month to hear the results, I guess its really involved testing for tons of diffrent mutations. I will be sure let you guys know the result.

 

[ShadowJason]

So I recieved some additional information regarding my EMG visit.

Assesment" Benign Fasiculation syndrome. Needle emg was abnormal with signs of increased membrane irritability. But there was no evidence of chronic denervation renerveration changes such as increased motor units,amplitude, duration, decreased recruitment , polyphasia. This may represent a channellopathy. Cliniclly the patient does not have atrophy or muscle weakness. "I do feel rubbery with increased perception of muscle fatigue" His symptoms started 2 years ago "not sure why he thinks that, I saw him 2 years ago to be evaluated for neuropathy, I did not have the twitching then". Yhis argues against ALS. Nerve condctin study was negative for Polyneuropathy.

So I am totally confused not, how could I have BFS with diffuse Fibs and Psw and increased insertional activity?

And is it possible that the EMG was done to early to show neurogenic MUP's

What is membrane irratability? is that a general term for the Fibs and Psw?

I am going to persue the muscle biopsy, and his only recommendation to see him in 6-12 months for another clinical and possibly EMG.

Thanks in advance!

 

[brooksea]

But there was no evidence of chronic denervation renerveration changes such as increased motor units,

That is your answer. Instead of reading here, please research the disease process in ALS.

You can feel good knowing you do NOT have ALS. Get the muscle biopsy.

 

[glupavomomiche]

I agree with brooksea!

 

[notme]

In ALS, the damage is being done long before symptoms develop. You don't mention what your symptoms are, but something sent you to the neuro in the first place.

The line Brooksea pointed out--this means there is no ALS. In ALS, early in the process, the nerves are able to 'fix' themselves. Renervation and denervation. There would be both seen. (Again--this can be before you've even noticed anything at all) The revnervation is the nerve trying to 'control' the muscle. The denervation is the connection being gone. Both are seen early.

Relax. Check About BFS -- there is a support place for them. Something is going on--but thankfully, it doesn't appear to be ALS

 

[edwards5257]

NotMe and others
GOOD information about NO ALS. I have to continue to believe this also, even though things are not right, and a tentative diagnosis of small fiber neuropathy. THANKS again!
Ill call in three weeks for my results, although the EMG/NCS (second ones) were o.kl.

 

[Robynnblue]

Hi ShadowJason...I run a chat room for people with BFS...and I have a member on there that has been there for a year now with your exact EMG findings..its actually not uncommon with some BFSers...I think you should have any other testing that your neuro wants to do, just so you can clear all channels, but I wouldnt be a bit surprised if the test all show nothing... If you would like to join us on the chat room..just leave me a visitor message on my profile page here and let me know and I will send u the link over to your page.

Take care and breathe..I really think you may be looking at a BFS diagnosis..

Robynn LeAnne

 

[sadiemae]

Thanks Robynn. The BFS site is really a good one. I spent a couple hours browsing the site a couple days ago. Since I refer people there, I figured I needed to read up on it. You all do a great job.

 

[Robynnblue]

Thanks Sadiemae.I'm glad u like it...I dont do much on the BFS site these days..but stick mostly to running the chat room for BFSers...I like it better...its more personable and I like being able to provide immediate answers for anxious twitchers...try to save them some grief lol..

Hugs

Robynn LeAnne

 

[ShadowJason]

Thanks for the input guys, I think I have a better understanding of the situation. I know there are "no for sures in life" but ALS does not seem likely. I need to listen to the Nurologist and continue to figure out what is wrong.