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paul71

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Hi again, just to briefly reintroduce my story, I have had several EMGs in recent months. Some were normal, others were not. I have had classic UMN symptoms - hyperreflexia (4+), spasticity, heavy legs, pain... Here is a summary of my "worst" EMG, of my arms back in November:

EMG of my arms and found "increased insertional activity, fibrillation potentials, increased recruitment pattern, with polyphasic patterns in the biceps and triceps. EMG also found denervation in the left abductor pollicis brevis, suggesting a chronic denervation pattern." My left thumb pad is now much thinner than my right thumb pad.

My neurologist put me on Lyrica 50mg 3x/ day for nerve pain, and Zanaflex for my spasticity, which was becoming very painful in my legs.

Since that time, I had EMGs of my arms and legs by another neurologist, who found them to be normal. This has me thoroughly confused, of course.

I had a follow up appointment Tuesday. The neurologist found that I was MUCH less hyperreflexic. I don't feel better, but I would hope that this is good news.

My question is, does this indicate that perhaps my body is repairing itself, or can the Zanaflex make one less hyperreflexic? I know that hyperreflexia and spasticity are related, I just don't know if the drug can actually make one's reflexes more normal.

This is the first possible bit of good news that I've had in 5 months... I'm keeping my fingers crossed!
 
HI

You can ask Wright about EMG issues. It'll likely help him if you an post the actual report the doctor wrote up for you rather than summarizing like you've probably done.

Were it me I'd be happy the apparent 3rd EMG is normal? I'm taking it from your post that first was normal, second was not and third is? How far apart were they?

In ALS they look for denervation and renervation (I probably spelled those wrong) And, in addition to the EMG, they also look at the NCV--what did that report say? It is important as an NCV with abnormalities does tend to point away from ALS as well.

Who was the positive EMG from? A neuromuscular specialist or a tech?

I can't answer your questions about reflexes--but I do know that the Baclofen I take helps a lot with my spasticity and pain in my legs (along with the zanaflex or valium I take) -- and I wouldn't touch Lyrica--but that's just me. It works for some and if it's helping you--that's great. I don't think they are exactly why it helps with nerve pain--so I'm not sure that it can't affect or 'slow' reflexes, but that's pure conjecture on my point. What did the neuro say? Call and ask if the meds could cause a change. I really doubt 90% of the people here would know, as we aren't doctors :)

Remember -- it can only be ALS when it can't be anything else.

Personally, my neuro would not accept another doctors EMG--she wanted her own. And she's an als and neuromuscular disease specialist. It's important to see one that knows their stuff with serious suspicion of this disease in my opinion.

Normally in hand atrophy, it's first noted in the area between the thumb and forefinger--not so much in the pad of the thumb. (And in many other causes of hand atrophy)

My left hand which has 90% loss of strength and function has pronounced atrophy in it--very visible to everyone--and my thumb is nothing but bone--but the pad of my thumb hasn't changed that I can see. Did the doctor notice a change in yours or did you?
 
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Notme, thanks for your response.

Here is the timeline of my EMGs, which will explain my confusion:

10-11-12: EMG of legs - peripheral neuropathy (but no raw numbers given).

11-1-12: EMG of arms (done by nuero #2, AANEM accredited neuromuscular specialist) - abnormal. Quoting from the report: "EMG examination revealed increased insertional activity, fibrillation potentials, an increase of the motor units recruited for the degree of effort, with polyphasic patterns in the biceps and triceps musculature. There was also increased insertional activity, fibrillations, and high frequencey repetitive discharges in the abductor pollicis brevis on the left. No denervation was found in the paraspinal musculature. There is evidence of a myopathic recruitment pattern in the proximal muscles bilaterally, with slight denervation. There is denervation in the left abductor pollicis muscle with high frequency repetitive discharges suggesting a chronic denervation pattern."

11-6-12: EMG of legs (done by nuero #2) - normal

12-20-12: EMG of left leg and left arm (done by nuero #3, neuromuscular specialist who works at an ALS clinic) - normal.

So, over the course of 9 weeks, I had several conflicting EMGs by neuromuscular specialists. During this time, I have had extremely tight legs, joint pain, fatigue, a hand tremor, fasciculations, quivering muscles and weakness. My legs shake when I walk down stairs. Also, my NCV studies and MRI's were all normal.

However, my last appointment revealed that my reflexes are much more normal. I am wondering if this could be simply a good side effect of the Zanaflex or if it could mean that I had some unknown condition (spinal damage?) that could be repairing itself.

I know this is a highly technical question. I wanted to know if any of you have had your hyperreflexia get better after using Tizanidine or Baclofen for spasticity. Thanks!
 
This is a question you should have asked your neuro. we are not doctors.

Did you ask for all those EMGs or did the doctors suggest you have them all in such rapid succession.? Why did you originally go to have an EMG? 3 different Neuros, are they working together or are you just changing docs because you do not like what they say? What do they say about your condition? Why did you go to an ALS clinic?

To me, it sounds like something is going on, but with normal NCV and normal EMGs, it is unlikely that it is ALS. I think it would be wise if you tried to calm down and stop self diagnosising with the inter net or this forum, pick one of the neuros that you liked best, and really worked with him to find out what is going on. jumping from doc to doc so quickly is reieinventing the wheel. I know you are scared but you are not serviing youself by what you wrote here. I know you probably feel helpless but you ahve to let the experts do their jobs.
 
I asked the doctor and he was, in his words, a bit puzzled... my situation started with with a reaction to an antibiotic, although in the months before that, I did notice that my calves were getting very tight.

I was not doctor shopping. Here's what happened:

I was referred to the first neurologist after my GP noticed my new onset hand tremor after my adverse drug reaction. This neurologist peformed an EMG but he was not "my neurologist". I even asked him if there would be a follow up and he said, "I just do the test." He referred me to the 2nd neurologist.

The 2nd neurologist performed his own EMGs because the first neurologist did not provide him with raw numbers or take skin temperature readings. Basically, the test was useless. So after several tries to get the raw numbers, the 2nd neuro did his own testing, which contradicted the first's neuro's results.

He then referred me to the 3rd neuro after he found evidence of myopathy or possible MND. The thought was that the 3rd neuro could possibly do a muscle biopsy. (My neurologist can't do a muscle biopsy in his office since the sample needs to be fresh.)

I did not actively shop from one doctor to another. The 2nd neurologist is "my" neurologist. Current plan is to see him again in two months. I have a lot of confidence in him. I'm just trying to learn from the experiences of others that have gone through this.

All the testing was initiated by the doctors because of my rapid onset of syptoms - pain, muscle weakness, hand tremor, spasticity, hyperreflexia, and elevated CK within a 1 month period.
 
Hey Paul

Your latest EMG was normal because you have healed. The signs of active denervation in an EMG will disappear as soon as that denervation has been remedied (i.e. reinnervation). It's just that simple. The only way it wouldn't is if you had chronic denervation (i.e. your condition was progressive).

If you got another EMG in a few months, it will undoubtedly show larger and/or longer duration MUAP's, indicating reinnervation (reinnervation takes time to show-up on an EMG).

If your UMN signs and symptoms are getting better, then once again, you are healing.

All of that sounds like great news to me.
 
I knew Wright would come to the rescue.

I'd suggest if things got worse, you go back...

Good luck
 
Thank you, Wright. I have looked at the timeline of EMGs and hope that I am improving. I am not feeling it yet but the reflexes getting more normal has me hopeful. My neurologist acknowledged that we might never know what truly happened. I just pray that my symptoms can slowly go away. In the meantime I have learned the hard way not to push too hard. Whenever I do I pay for it for a couple days. I am working, stretching, walking and other than that basically resting. I am continuing on lyrica, zanaflex and tramadol, all at minimal doses.

Next neurologist appointment is April 16th. Keeping my fingers crossed... Paul
 
It almost sounds more like some kind of myopathy rather than muscle death caused by fried nerves. At least I hope so! Let me know what you hear in April--but in the meantime, try and put it out of your mind--believe me it can drive ya batty if you don't.

I have "I'm going nuts worrying" T-shirts for sale :)
 
think i need a batch of your tshirts not me ! somedays i do get to wear the It might be ok oneday tshirt!
 
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