EMG Accuracy - Your opinions Please :-)

[dannyr]

Hi There,
I have an EMG this week coming up..what concerns me is how so many people say CLEAN EMG = NO ALS...

Then...... as soon as people have said they have a CLEAN EMG there are so many people say to the person don't trust the first EMG as it might be just a technician and NOT a Neuro specialist.....I find it amazing that an EMG is not done by someone who is efficient in looking for Neuro disorders such as MND/ALS...what do u think?

Also if you have a clean EMG and obvious atrophy and fasciculations which has been seen and confirmed by doctors, then WHY would it show as clean?

Thanks for any constructive feedback. Danny

 

[edwards5257]

I have wondered the same thing from time to time.

 

[Nighthawk]

Essentially, any licensed provider may perform an EMG. As a result, outcomes may vary widely from physician-to-physician due to training, experience, and the accuracy with which they perform tests.

As far as reliability, it's usually pretty good, honestly. All the test really does is to send electrical pulses down your nerves to determine whether there are any obstructions in your nerve pathways.


By the way, try to keep all your questions/concerns under a single thread, it would be easier to address that going back and forth trying to locate every one of them.


NH

 

[dannyr]

Thanks for your reply Larry and Nighthawk.

I just find it amazing that such an important test that has been requested for Neurological symptoms could be performed by someone who is not fully trained or not experienced enough, surely they should be shadowed by someone senior until proven fully capable of performing an EMG accurately. Obviously human mistakes happen, but this would stop a lot of worry for people already concerned about taking the EMG in the first place.

Also has anybody got an input on how would an EMG come back CLEAN when patient presents with confirmed atrophy and fasciculations and the test was done on the specific limbs with the issues?
Thanks again Danny

 

[olly]

It is always best to get an emg done by your neuro,even if you have had one done by another doctor your neuro may want to do it again.

As nighthawk said they are reliable ,they can pick up problems in a limb even before symptoms are present.
The results depend on whats going on .........but it can tell if theres any active desease process(denerviation) going on at that time or if there was but its getting better.
With someone who has localized atrophy but a "clean" emg its is probably the latter case..........this could be due to trauma,neuropathy or many other things.
Wright is our emg expert and pops in sometimes.......maybe look up a few of his old posts as i know he has explained all this to others.

 

[derec]

You say it man. I am wondering about this everyday...
I had two "clean". But I do have confirmed atrophy, visible twitches, swalloing issues, perceived weakness... just all that crap you don't want to have. How could those EMGs come out clean?

At least it gives me some hope...gn8

 

[olly]

Derec, if they were clean then it means theres no "active" desease process going on........reinerviation may have been picked up meaning the muscle and nerves are healing.
Have you or danny had a nvc done to check for neuropathy?

An als patient can have say atrophy and weakness in the hand and no other symptoms .........but an emg on other limbs can show active denerviation.
So if active denerviation is going on before symptoms even begin, symptoms develop(these are noticeable) then the damage starts to heal before your emg you will get a "clean" emg that shows reinerviation........you may have symptoms for a while but eventually it should get better depending on amount of damage.

 

[vickim]

I have diagnosed muscle weakness in my shoulders, arms, legs, and hips and neck. I have had 3 emgs/nvcs and it showed neuropathy in my feet. I don't have als, I have mitochondrial myopathy. It is a muscle disease. I have twitching, cramps, among other sensations. What I am trying to say is it doesn't have to be als it can be another type of disease.

Give the drs a chance to figure it out. It took 5 years to get mine. These diseases are hard to diagnose and they mimic each other. It may take months or years. Repeating of tests. I had a muscle bio and to get my answers.

Getting frustrated with the kind people here will get you nothing. Yes the process is frustrating and terrifying, I know, been there and done that. But when these people here tell you their opinion (and that's exactly what it is) you should thank them and move on. Not only als causes these symptoms.

I wish you all peace and pray you get answers.

 

[dannyr]

Vicki - Whos getting frustrated with the kind people giving there opinions? Nobody. There are no issues from anybody. Keep smiling.

 

[Nighthawk]

Vicki - Whos getting frustrated with the kind people giving there opinions? Nobody. There are no issues from anybody. Keep smiling.

She did not mean it the way you perhaps understood it.
I guess she meant was that you should just wait for your upcoming appointment and get your EMG done and the results of it discussed with your Neuro and stop worrying.
Then, after that, you may wanna come back here and let us know how it went.
That's all.

NH

 

[ottawa girl]

DannyR,

I can only speak to my experience. The EMG was done by the neurologist. His technician did the nerve conduction test.

If you want a second look at your EMG results, get a copy and then ask WRIGHT here to have a gander. He's the forum resident guru.

Good luck

 

[Annie's Phil]

As we all know, ALS is a progressive destruction of motor neurons. Likewise, in the case of ALS the emg will progressively change in proportion to the damage done to the motor neurons innervating a particular muscle. Early in the disease the changes in the emg can be subtle and that's where a neurologist specializing in electrodiagnostic testing is more likely to recognize the early tell-tales of motor neuron disease. Later in the disease, the changes in the emg are more blatant. So what a neurologist with less experience and expertise in reading electrodiagnostic results might regard as "clean" or non-conclusive another neurologist specializing in electrodiagnostic testing might regard as definitive for ALS.

This was the case with Annie. It was the head of the electrodiagnostic neurology department that made the diagnosis. She was exceedingly competent. Another aspect was the way in which she went about the testing. As she tested one muscle and saw the results she then asked questions that gave her insight into which muscle to test next. So she didn't just do a "standard" emg test, but very intelligently tailored the test to what she was seeing.

We went to get that test already having a diagnosis of multifocal motor neuropathy and were expecting a routine confirmation. During the testing I asked the Dr. if it looked like MMN, she very quickly and definitively replied "No, this is a motor neuron disease." As you might imagine my heart just fell to the floor. Annie didn't yet know what that meant and I had to tell her on the way home. A very hard day.

So doctors who have a lot of intelligence and experience with electrodiagnostic testing will detect pathological results in the emg sooner, but eventually it will progress to the extent that any neurologist can see it.

 

[derec]

Thank you vickim and olly! In my case the ncv (back in march) was also unremarkeable...
well thats just it... wait and see... I guess!

best, D.

 

[vickim]

Thank you NH , I guess I did not explain my self clearly. Everyone who comes to this DIHALS thread should keep an open mind. Don't narrow in on just als. It could be anything, and until they have exhausted all other possibilities. My disease can affect all parts of the body, because there is mitochondrial cells in every cell in the body and is what makes energy for the cells to function properly.

During my journey I was thinking anything from MS, cancer, als to MD (which mito is a form of). I did not zero in on one thing. I was terrified of it all. And after all the fretting, tears and fears I have a diagnosis but it doesn't change anything, there is nothing they can do except treat the symptoms and I am still living my life as before the diagnosis. I do what I can and enjoy what I can. I appreciate what I can do a little more and mourn what I can't.

It is a long hard journey and you will feel like you are going crazy, no one is on your side, getting passed from one dr to another and tests upon tests. Meanwhile you feel like your life is passing you by and things are getting worse and you think no one is doing anything to help or figure it out. They are but it doesn't happen over night, its not until there is a certain degree of symptom progression that they can start narrowing it down.

 

[pearshoot]

there are supplements that provide energy to the cells. i have been taking one since day one. i am the one called cruel for suggesting there are things you can do to extend life expectancy but i still beleive it