Emg question! Wright, anyone?

[Tiname]

Hello!

I have read many places that in ALS there is something called reinnervation period or process. The healthy motorneurons manages to replace the dying ones as long as they can. But when there are no healthy motorneurons left to replace the ones who dies off this period will of course be over.... It also says that in this reinnervationtime there might not be ANY signs of weakness or other things pointing towards als, EXCEPT, fascikulations which comes as a consequense/reaction because the nerves tries to repair themselves during this period....

I find this scary.. I have not found out how long this reinnervation time takes before obvious signs of weakness will show up. Do You know? Months, year?

Would it show up on the EMG?

Thanks in advance!:!:

 

[ottawa girl]

Tina,

You have many threads on an ALS forum. In re-reading your ten threads, it seems clear to me and others that you do not have ALS. Wright, bless his heart, answered your questions.

Below is, I think, his best reply to you.

" Fasciculations can be found on an EMG and the EMG be deemed normal. This is not an uncommon finding. If you had fibrilations and PSW's and fasciculations, then your EMG would be deemed abnormal . . . BUT . . . the abnormal findings could be due to many, many, many, many, many different things (almost all of them treatable or at the very least, not life-threatening whatsoever).

You had a completely normal EMG (as you stated), so why are you asking these questions? Be happy and move-on with your life instead of obsessing about a disease you clearly do not have" .

 

[bluedog]

I believe that you are correct. In ALS, if the disease is slow enough, collateral sprouting can keep pace with horn cell death, and you can maintain up to 90% of your strength for a while. And fibs and psw might not appear due to the sprouting keeping pace. Eventually, though, you would lose strength. The timing of the loss of strength would vary by patient.

Your last EMG was abnormal (Wright was talking about your first one) in that it showed one large MUP. As the dr said, this could be due to an old injury. Since you are still worried, get another EMG if you can. The results will most likely be one of the following:

A. EMG still shows only the same large MUP in the same muscle with no spontaneous activity (fibs, sharp waves, fasics). This would strongly point away from ALS at this point and support the injury hypothesis. If it was an ongoing process such as ALS, although the fibs and psw might not show up, depending on the timing of the EMG, additional MUPs would because of the reinervation taking place, especially in your case, because it would be almost 4 months since your last EMG, and large MUPs appear 2 months or more after denervation.
OR
B. EMG shows additional large MUPs and, perhaps, fibs and psw. In this case, further investigation would be required. It still could be from an unresolved radiculopathy. However, if the large MUPs are in multiple regions (cervical, thorasic, and lumbar), that would tend to nullify the radiculopthy scenario because thorasic radiculopothies are more uncommon.

 

[Tiname]

Ok, this is of course scary.... My neuro said that both denervation and reinnervation should be present in als. I have fascikulations in all parts of my body, would those "eventually show up in the emg then, as large MUPS? Why do I only have mup in one muscle when I am twitching all over?
This is so difficult to understand! Help please....

 

[bluedog]

A large MUP means that denervation and then reinervation occured in the past. For ALS to even be a remote consideration, you would need active denervation too (fibs, psw, or fasics [detected by EMG, not visualized]) along with the MUP. You did not have active denervation, which is why your dr said injury instead of ALS, and because your symptoms and exam probably indicated no ALS.

You could have BFS, and the twitching could be from that.

Again, if you want more reassurance, get another EMG and see what it shows.