BernardBlack
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I posted a while back about my mother who had trouble swallowing and partial loss of speech / dysphagia back in december 2013 and we have now been through two EMGs, as her symptoms are more or less the same (although worsening a little bit).
The results look really bad yet the doctors do not want to give a diagnosis.
She's scheduled for another EMG in a couple of months but I would appreciate it immensely if someone could take a look at the results.
I apologize for the wall of text in advance. Although I understand that each persons time is precious I hope anyone has the time and opportunity to read this and give a comment.
First EMG (2013-12-19):
M VOCALIS BILATERAL, M CRICOTYROIDEUS BILATERAL
No certain spontaneous activity. All muscles show increased duration, amplitude potentials, sometimes of complex or polyphasic characters. At maximal activation a sparse activity was displayed with probable light to moderate loss of units. Changes were equal on both sides but the right vocalis muscle showed more rebuilt motor unit potentials.
ASSESSMENT
Moderate changes of neuro character in all examined muscies with loss of units and rebuilt motor unit potentials. Especially on the right side, it was clearly displayed and the EMG speaks of a change which is not recent. (Older)
Second EMG (2014-02-20)
M TRAPEZIUS diagnosed, TONGUE, M ORBICULARIS ORIS SIN, M ORBICULARIS C(cuts off)
No spontaneous activity. Substantially normally configured MUP. Normal interference pattern at maximum activation.
M ORBICULARIS ORIS diagnosed:
No spontaneous activity. Many MUPs were normal, but there was a sparse to moderate occurence of split duration MUPs with sometimes increased amplitude. In some needle positions there was a smal reduction at maximum activation, in other needle positions there was a normal interference pattern.
JITTER ANALYSIS WITH CONCENTRATION NEEDLE
M ORBICULARIS ORIS diagnosed: 20 potential pairs were registered with mean MCD 43 microseconds 18 of the potentials showed normal jitter. 2 showed increased jitter at 122 and 91 microsecond. One of the potentials was heavily split. (split may mean polyphasic)
REPETITIVE NERVE STIMULATION
Stimulation was done at 3hz during rest, directly after activation and 1 and 3 minutes after activation:
N FACIALIS WITH REGISTRATION FROM M NASALIS SIN:
Stable muscle responses without significant decrements or increments.
N ACCESSORIUS WITH REGISTRATION FROM M TRAPEZIUS diagnosed:
Stable muscle responses without significant decrements or increments.
ASSESSMENT:
- Repetitive nerve stimulation showed normal readings with registration from m nasalis and m trapezius.
- EMG showed normal readings in tongue and other bulbar musculature, aside from m orbicularis oris diagnosed. In this muscle there was a sparse presence of neurogene changes, mostly of chronic character.
- Jitter analysis using needle shows increased jitter on 2 of 20 potential pairs. This is considered related to the neurogene changes.
CONCLUSION:
No electrophysiological basis for neuro changes considered to be Myasthenia Gravis.
In denervation in bulbar musculature. Small neurogene changes in M orbicularis oris sin.
In conclusion with the previous EMG there is no evidence or basis for motor neurone disorder.
These are translated from another language, but it should be factually correct, aside from some clumsy wording.
I have read the results and compared them to this booklet:
http://www.zielinskifam.com/lit/neuro/als/emg-early-als.pdf
I'd love for this to be anything but ALS; but there are a lot of checkboxes ticked in the booklet. We haven't even been scheduled yet for the next EMG (they keep saying it's a couple of months away), and we are thinking about going abroad for help. We are located in Europe, thinking about traveling to Israel where there seems to be some exciting progress being done there. If anyone has any tips for European ALS clinics that can provide a better diagnosis and/or are doing experimental research, please write as well.
Thank you for your time.
PS2.
Previous thread here:
https://www.alsforums.com/forum/do-i-have-als-als/24455-possible-pbp-als-need-help.html
The results look really bad yet the doctors do not want to give a diagnosis.
She's scheduled for another EMG in a couple of months but I would appreciate it immensely if someone could take a look at the results.
I apologize for the wall of text in advance. Although I understand that each persons time is precious I hope anyone has the time and opportunity to read this and give a comment.
First EMG (2013-12-19):
M VOCALIS BILATERAL, M CRICOTYROIDEUS BILATERAL
No certain spontaneous activity. All muscles show increased duration, amplitude potentials, sometimes of complex or polyphasic characters. At maximal activation a sparse activity was displayed with probable light to moderate loss of units. Changes were equal on both sides but the right vocalis muscle showed more rebuilt motor unit potentials.
ASSESSMENT
Moderate changes of neuro character in all examined muscies with loss of units and rebuilt motor unit potentials. Especially on the right side, it was clearly displayed and the EMG speaks of a change which is not recent. (Older)
Second EMG (2014-02-20)
M TRAPEZIUS diagnosed, TONGUE, M ORBICULARIS ORIS SIN, M ORBICULARIS C(cuts off)
No spontaneous activity. Substantially normally configured MUP. Normal interference pattern at maximum activation.
M ORBICULARIS ORIS diagnosed:
No spontaneous activity. Many MUPs were normal, but there was a sparse to moderate occurence of split duration MUPs with sometimes increased amplitude. In some needle positions there was a smal reduction at maximum activation, in other needle positions there was a normal interference pattern.
JITTER ANALYSIS WITH CONCENTRATION NEEDLE
M ORBICULARIS ORIS diagnosed: 20 potential pairs were registered with mean MCD 43 microseconds 18 of the potentials showed normal jitter. 2 showed increased jitter at 122 and 91 microsecond. One of the potentials was heavily split. (split may mean polyphasic)
REPETITIVE NERVE STIMULATION
Stimulation was done at 3hz during rest, directly after activation and 1 and 3 minutes after activation:
N FACIALIS WITH REGISTRATION FROM M NASALIS SIN:
Stable muscle responses without significant decrements or increments.
N ACCESSORIUS WITH REGISTRATION FROM M TRAPEZIUS diagnosed:
Stable muscle responses without significant decrements or increments.
ASSESSMENT:
- Repetitive nerve stimulation showed normal readings with registration from m nasalis and m trapezius.
- EMG showed normal readings in tongue and other bulbar musculature, aside from m orbicularis oris diagnosed. In this muscle there was a sparse presence of neurogene changes, mostly of chronic character.
- Jitter analysis using needle shows increased jitter on 2 of 20 potential pairs. This is considered related to the neurogene changes.
CONCLUSION:
No electrophysiological basis for neuro changes considered to be Myasthenia Gravis.
In denervation in bulbar musculature. Small neurogene changes in M orbicularis oris sin.
In conclusion with the previous EMG there is no evidence or basis for motor neurone disorder.
These are translated from another language, but it should be factually correct, aside from some clumsy wording.
I have read the results and compared them to this booklet:
http://www.zielinskifam.com/lit/neuro/als/emg-early-als.pdf
I'd love for this to be anything but ALS; but there are a lot of checkboxes ticked in the booklet. We haven't even been scheduled yet for the next EMG (they keep saying it's a couple of months away), and we are thinking about going abroad for help. We are located in Europe, thinking about traveling to Israel where there seems to be some exciting progress being done there. If anyone has any tips for European ALS clinics that can provide a better diagnosis and/or are doing experimental research, please write as well.
Thank you for your time.
PS2.
Previous thread here:
https://www.alsforums.com/forum/do-i-have-als-als/24455-possible-pbp-als-need-help.html