EMG done, but neurologist slow - your thoughts?

[ngrant]

Its tough to plan for your future with ALS hanging over you and the doc is slow to respond. He's had the EMG results for 3 weeks and now has a brain MRI. Next appointment is in 60 days - I've asked twice for a call or something. UC Davis Neurology, a "heavily impacted" facility.

Here's what I know. What do you think?

I noticed a "balance" problem while mountaineering (falling down sometimes) and slight tremor in hands. Neurologist said I had an unstable gait, unable to tap my feet quickly and a reverse reflex in my feet, suggesting significant nerve problems. He ordered EMG, spine MRI and brain MRI.

EMG resident said my motor nerves are blocked and sensory nerves are OK. I don't have a balance problem, I really have a problem placing my feet on uneven terrain. He said it is a rare condition (in a very grave voice) but naturally wouldn't say what. He noticed significant wasting of muscles in my feet and lower legs and said I was lucky to be athletic or I would be having much worse problems right now.

It is progressive. I noticed it about a year ago and now I do have foot slap with certain shoes and a constant numb/tingly sensation in my feet.

Time to prioritize that bucket list?

I know it varies, but any guesses on how long I'll be on my feet? As a skier, climber and mountaineer there are few trips I'd like to plan. Probably impossible to tell, but would be nice to know if its a year vs. two years, etc.

Thanks!

 

[Nikki J]

Request your medical records you have the right to them. My medical center will email them securely with a faxed authorization. Search for medical records UC Davis and find out how. You do not have a diagnosis and even if you did prognosis varies wildly in ALS. It sounds to be more like your ncs was abnormal than your emg which means you are looking at something else but that is guess. If you had your report you would know ( or we could probably help you figure it out)

 

[Atsugi]

NGRANT, it sounds like you're personally planning on ALS. Must be depressing. Also, it's needless jumping to conclusions. There are other conditions you might have, not fatal ones.

As Nikki said, get your med records tomorrow morning. Push that doc, too. Nobody should have to wait so long. My doc gives me results ASAP.

In the meantime, don't assume the worst. You don't know. You're not a doc.

 

[ngrant]

Thank you. I'll back up and not assume ALS.

I did just now request my records.

Thanks again.

 

[ngrant]

Here are my EMG summary results. You guys are right - I'm not a doc and don't know what this means. Thanks for reminding me of this. I have the detailed numbers that I can post if needed.

Interesting that my neurologist in his report in December commented, "upgoing toes bilaterally" which I was told later meant upper neuron problems (bad) but the EMG tech/resident comments, "Plantar response mute bilaterally" which I think is good, or least not bad.

ELECTRODIAGNOSTIC FINDINGS:

1. Marked amplitude reduction and temporal dispersion of compound
muscle action potentials with prolonged F-wave latencies in the
left tibial nerve.
2. Moderate amplitude reduction and temporal dispersion of
compound muscle action potentials with norml motor conduction
velicity in the left peroneal nerve and right tibial nerves.
3. Normal motor conduction velocity and compound muscle action
potential amplitudes in the left median nerve.
4. Normal sensory conduction studies in the left sural,
superficial peroneal and median nerves.
5. Except for moderate reduction of insertion activity in left
lumbar paraspinal muscles there were no other significant
abnormalities.

CLINICAL IMPRESSION:

Abnormal study. There is evidence of significant motor axonal
loss in nerves of the lower extremities, in particular on the
left side. There is no evidence of involvement of sensory nerve
fibers. The underlying cause for these findings is unclear, but
it may be related to a motor peripheral neuropathy or a remote
radiculopathic lesion involving nerve roots proximal to the
ganglia of the posterior roots. Correlation with MRI findings of
lumbar MRI and work up for peripheral neuropathy are recommended.

THANKS!

 

[Nikki J]

A mute babinski is not bad usually.
This looks like an abnormal ncs rather than emg ( shock part not needle part of test). This points away from ALS they want to see if you have nerve damage from a back problem hence the mri recommendation and go from there. It does not seem ALS is on the table. There is no mention of denervation. When you look at the report you will see columns for fibs, psws do any of them say anything other than nml or zero?

 

[Atsugi]

I'm not a doctor, so I hope to be corrected as needed, but that looks like an NCS, not an EMG.

 

[ngrant]

Here are the complete results, including EMG. The EMG line for Tibialis isn't all normal, but not sure if that is significant.

Motor Nerve Conduction:

Nerve and Site Lat Amp Segment Lat
Diff Dist CV Temp

Tibial.L
Ankle 7.5 ms 2.0 mV Abductor hallucis-Ankle 7.5 ms mm m/s 30.3
degC
Popliteal fossa 16.6 ms 1.1 mV Ankle-Popliteal fossa 9.1 ms 400
mm 44 m/s 30.1 degC
Peroneal.L
Ankle 6.4 ms 3.1 mV Extensor digitorum brevis-Ankle 6.4 ms mm
m/s 29.8 degC
Fibula (head) 13.9 ms 2.2 mV Ankle-Fibula (head) 7.5 ms 305 mm 41
m/s 29.9 degC
Popliteal fossa 16.4 ms 1.9 mV Fibula (head)-Popliteal fossa 2.5
ms 120 mm 48 m/s 29.8 degC
Tibial.R
Ankle 5.8 ms 3.9 mV Abductor hallucis-Ankle 5.8 ms mm m/s 29.1
degC
Popliteal fossa 16.1 ms 3.9 mV Ankle-Popliteal fossa 10.3 ms 440
mm 43 m/s 28.9 degC
Peroneal.L
Fibula (head) 4.9 ms 7.3 mV Tibialis anterior-Fibula (head) 4.9
ms mm m/s 29.1 degC
Median.L
Wrist 4.0 ms 10.9 mV Abductor pollicis brevis-Wrist 4.0 ms 80 mm
m/s 32.2 degC
Elbow 8.9 ms 9.5 mV Wrist-Elbow 4.9 ms 280 mm 57 m/s 32.1 degC

F-Wave Studies

Nerve M-Latency F-Latency Temp (degC)
Tibial.L 16.6 66.8 29.9

Sensory Nerve Conduction:

Nerve and Site Peak
Lat Amp Segment Lat
Diff Dist CV
Temp

Superficial peroneal.L
Ankle 3.7 ms 8 mV Dorsum of foot-Ankle 2.9 ms 135 mm 47 m/s 29.4
degC
Sural.L
Lower leg 4.3 ms 8 mV Ankle-Lower leg 3.3 ms 140 mm 42 m/s 29.1
degC
Median.L
Wrist 3.5 ms 10 mV Digit II (index finger)-Wrist 2.7 ms 140 mm 51
m/s 31.9 degC


Needle EMG Examination:

Insertional Spontaneous Activity Volitional MUAPs Max Volitional
Activity
Muscle Insertional Fibs + Wave Fasc Duration Amplitude Poly
Config Recruitment Amplitude Pattern Activation/Effort
Tibialis anterior.L Normal None None None Increased Sl. Incr.
None Normal Mildly reduced increased Full Max.
Gastrocnemius.L Normal None None None Normal Normal None Normal
Normal Normal Full Max.
Semimembranosus.L Normal None None None Normal Normal None Normal
Normal Normal Full Max.
Tensor fasciae latae.L Normal None None None Normal Normal None
Normal Normal Normal Full Max.
L5 paraspinal.L Normal None None None Normal Normal None Normal
Normal Normal Full Max.
L4 paraspinal.L Normal None None None Normal Normal None Normal
Normal Normal Full Max.
L5 paraspinal.R Normal None Rare None Normal Normal None Normal
Normal Normal Full Max.

 

[Nikki J]

i would not think ALS here. Try to relax until you get to talk to the doctor. Think they will say something else altogether

 

[ngrant]

Thank you Nikki,

It would be interesting to know what the darn EMG results actually are. Not what they mean, just formatted correctly. They came in that way through the online portal, but I don't know the terminology enough to line up the columns.

For example, here are two of the rows not completely normal:

Insertional Spontaneous Activity Volitional MUAPs Max Volitional
Activity
Muscle Insertional Fibs + Wave Fasc Duration Amplitude Poly
Config Recruitment Amplitude Pattern Activation/Effort
Tibialis anterior.L Normal None None None Increased Sl. Incr.
None Normal Mildly reduced increased Full Max.
L5 paraspinal.R Normal None Rare None Normal Normal None Normal
Normal Normal Full Max.

Can anyone line these up correctly?

Thank you.

 

[lgelb]

Is there a word or two missing? Can't make it line up since number of columns different, but from what I make out, no or rare abnormal spontaneous activity was seen, which means little to no "acute denervation," which is great news. And no markedly abnormal motor unit morphology is similarly hopeful, pointing to a conduction issue rather than ongoing nerve damage. The NCS suggests less dire issues than ALS.

 

[ngrant]

Thank you for your time! I appreciate it. I'll wait for the doctor with much reduced stress. Still be nice if he got back to me. Geesh.

I'll report back when I hear from him - it could be my next appointment late April.