Old 07-26-2008, 11:40 AM #1 (permalink)
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Default Is This True About Als And The Emg?

Is the EMG just a diagnostic tool to differentiate between nerve disease or muscle disease? The way I understand the function of the EMG in diagnosing ALS, is that it only shows lower motor neuron involvement, is this a true statement? I read alot of posts about muscle twitching and a dirty EMG and everyone thinks they have ALS. I am not convinced anyone has ALS until they show all of the above and upper motor neuron involvement and everything else ruled out. I am very confused, what constitutes a definitive diagnosis of ALS? Are there any ramifications of this one neurologists report out there for insurance companies to see, which I believe he is wrong. I am still waiting to go the MDA clinic but will this report come back to haunt me? I guess me obtaining any supplemental, life or disability insurance is now unlikey.
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Old 07-26-2008, 11:59 AM #2 (permalink)
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The standard for diagnosis is called El Escorial Diagnostic Criteria

The diagnosis of Amyotrophic Lateral Sclerosis [ALS] requires:
A - the presence of:

(A:1) evidence of lower motor neuron (LMN) degeneration
by clinical, electrophysiological or neuropathologic examination,

(A:2) evidence of upper motor neuron (UMN) degeneration
by clinical examination, and

(A:3) progressive spread of symptoms or signs within a region or to other regions,
as determined by history or examination,


together with
B - the absence of:

(B:1) electrophysiological and pathological evidence of other disease
processes that might explain the signs of LMN and/or UMN degeneration, and

(B:2) neuroimaging evidence of other disease processes that might explain the
observed clinical and electrophysiological signs.

You're correct that an EMG does not show upper neuron involvement
The following is from a Canadian website that I found to be very helpful:

Signs and Symptoms
Upper Motor Neuron Degeneration

* muscle stiffness or rigidity
* emotional lability (decreased ability to control emotions)
* excessive fatigue
* dysphagia (difficulty swallowing)
* dyspnea (shortness of breath)
* dysarthria (a speech disorder caused by impairment of the muscles used for speaking)
* incresed or 'brisk' reflexes
* gait spasticiy


My neurologist also told me that she is withholding a complete diagnosis of ALS (for me) until there are EMG's from three separate locations that are problematic. (So far I just have the vocal cord dirty EMG) .... I think that is standard to, although I didn't see it in this "El Escorial " ...
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