Old 05-16-2017, 05:07 PM #1 (permalink)
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Default FALS -- changing symptoms?

I hate to post here. My focus in this forum has been on getting advice for my mother, who has ALS. But I'd like to know if I should seek yet another opinion and get another EMG for myself. Also, I'd like to know what peoples' experience has been with quick, brief EMGs.

My mother has ALS. She's in her late 70's and is in the end stages with an FVC of 37. 24 hour Trilogy machine. So, I'm well versed in ALS and the diagnostic tests; however, maybe my judgement is flawed with respect to myself.

Back in November 2016 I had a concussion followed by several upper limb neurological symptoms such as numbness, weakness and trouble gripping things. Bilateral. The diagnosis was cervical radiculopathy, which was sort of consistent with severe disk herniation in the cervical MRI, but EMG/NCV done by physiatrist were negative. Needle portion lasted maybe 10 minutes tops.

In March, many of symptoms had cleared. No more numbness. Overall upper body strength and soreness in neck were largely improved. Right arm completely back to normal. But weakness in parts of my non-dominant, left arm persisted, particularly when I was holding a phone or plate while arm is bent at more than 90 degrees. I started to have widespread fasciculations, but mainly away from the weak arm. They would occur in the legs, arms, sometimes oblique muscles, most often after I woke up.

I went to see the Director of an ALS Clinic at a university. She noted that my clinical exam was normal. EMG/NCV was normal. The EMG chart shows 0 fasciculation potentials. HOWEVER, she noted that she did see sporadic fasciculations which she determined were benign. She poked a lot of muscles, including paraspinals, and asked me to contract my muscles, but the needle was in each muscle for maybe 10 to 20 seconds tops.

So, fast forward to the present. I continue to have the weakness with holding things with that non-dominant arm. Fasciculations. I seem to have some atrophy and discoloration in the muscle between thumb and second finger, but it may have always been there. I don't know. I also have definite early fatigue in my rotator cuff: trouble directing shopping cart with non-dominant arm. So it's not just ulnar.

It's been six months since the "injury," if that's the cause. Any thoughts on whether it's time for another EMG? Is it possible for observed fasciculations to not show up as FPs on an EMG? Anybody have experience with DC area clinics? If so, would love to PM. This may seem like anxiety. I guess I could just sit and wait and see if things get worse. But with a mother who has ALS, a grandmother who died of Parkinson's in 4 years and the sudden onset of fasciculations and perceived weakness, it's really tough for me to think that this is all benign.
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Old 05-17-2017, 04:04 PM #2 (permalink)
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Default Re: FALS -- changing symptoms?

all of my husband's early EMGs were read as negative. he could feel the fasciculations in his abdomen. showed up later as slight irregularity in thoracic spine area. good luck and try to live in the moment and not focus on this. you could get hit by a bus way before you are ever possibly diagnosed with anything at all. I don't mean to seem flippant- ive been through the ringer and can't imagine your pain. my point is, live your life. Now. Today.
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Old 05-17-2017, 10:40 PM #3 (permalink)
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Default Re: FALS -- changing symptoms?

I don't see any reason to suspect ALS.
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Old 05-18-2017, 07:49 AM #4 (permalink)
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Default Re: FALS -- changing symptoms?

Astugi and Mnatale, thanks for your comments. Mnatale, I'm very sorry for your loss. As a fellow CALS, I am struggling daily with my PALS' illness. It's devastating. Every few days there is a new loss. Did your husband have any other symptoms at the time of the clean EMG's? Was it just fasciculations that made him go to the neurologist?

I was able to see the community neurologist yesterday. He diagnosed me with BFS and arm weakness from the C5/C6 pinched nerves in the neck. Normal clinical exam in all other regards. I have a hard time accepting that widespread fasciculations that started shortly after the weakness and other neurological symptoms are unrelated and benign. But it's overall good news.

If it weren't for my mother's health, I probably would have moved on mentally by now. Maybe I should be posting on the CALS page? But this isn't some kind of health anxiety-driven delusion. The weakness and fasciculations are real!
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