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tms23

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Hello,
i am 28 years old and had clinical diagnostic two weeks ago. I think i am on the way to have ALS, do you share my anxieties?

I went to the hospital (University hospital) due to twitches 24/7 all over my body. In March it began with cramps in my calves. Two weeks later also in my arms, shoulder and back. The neulologist did and EMG and NCV. How do you interpret these findings:

NCV:
- in both legs reduced: 30-40 m/s
- motor Amplitudes reduced: 2,0-2,9 mV
- sensible neurography normal
- NCV in arms ok

EMG:
- fasciculations in several muscels
- no fibs or PSW
- the muscle of my thumb has an high MUP of 4,8mV (they located three regions in this muscle, only the one has this high MUP)

Today, i have also twitches in my face and sometimes in my tongue. But i can not see fibillations when i look into a mirror. I have no weakness yet, but my endurance is getting worse:(

How do you interpret these findings? I need help, i think i have ALS!

Tim
 
Hello,

no fibs or PSW
no atrophy and no weakness


your main symptom are fasciculations. You can not be diagnosed with als on the basis of fasciculations only. How does your neurologist interpret the findings? (he/she after all is an expert)
 
But i have an high MUP of 4,8mV:(
And i have these fasciculations recently (2 month). May be the EMG findings are not reliable yet?

I forget to write, that they also did a tetany EMG that was positive. What is about that?

The neurologist is an expert in ALS in Germany. But the first he said when he saw me was: "You are too young." But this disqualified him in my eyes....
His diagnoses were: motor neuopathy and tetany syndrom.
 
There is a sticky on this part of the forum (above) titled "Requirements for ALS Diagnosis", featuring eloquent contributions by ZenArcher and Rose. I hope this may shine some light as to why your neurologist suggested alternative diagnosis. All the best.
 
tms23

The increased motor unit action potential (MUAP) indicates reinnervation and therefore at some point in time (there is no way of telling when . . . it could have happened 6 months ago or 6 years ago) you had denervation followed by reinnervation. The denervation was an isolated event (could have been due to impingement of a nerve, slipped disc, etc., etc.) that then stopped and was allowed to heal. This is evident by the lack of positive sharp waves and/or fibrilations, both of which indicate continuing denervation.

Motor amplitudes are not found with the NCV (motor amplitudes are the same thing as MUAP and are found in the EMG portion of the test). Are you sure it didn't say "compound muscle action potential (CMAP)" which is an NCV finding. You also didn't indicate in what muscles they found it. Without any of that information, I simply can't comment on it.

The decrease in conduction velocity found in your legs could indicate some type of myelin damage, but again, I can't comment fully because I don't know where in your leg those findings were made. Worse case scenario, the decrease in conduction velocity could indicate CIDP but given your lack of weakness or any other symptoms except for fasics, I would say that is highly unlikely. It's more than likely a non-specific finding.

Bottom line: That IS NOT the EMG of someone with ALS; it's not even close. I'm sure your neuro told you the same thing, so please try to relax.
 
@Danijela and wright
Thanks for your link and comments.

It's a pity i didn't get an exit interview. I just got a letter with findings i described above and the diagnose of motor neuropathy. But when i google, i find ALS under motor neuropathy.... That and the point of new faszilications in my mouth and at my throut let me get worried.

NCV:
N. peronaeus on both legs: 32 (lft) and 38 (right) m/s; CMAP left -28% and right -36%
 
What is a tentany EMG? Do you know how your reflexes are? normal, brisk, absent
 
my reflexes are brisk and symmetric. Tetany EMG is and EMG under hyperventilation.
 
Hi,
since a few days my tongue feels odd and i have tooth marks on the one side of my tongue. Is it possible to feel the fibrillation in the tongue? And is it possible to have twitches all over the body (also face) and bulbar onset?
Thanks, Tim
 
tim are you being diagnosed with ALS , because I see so in your profile next to you text ?
A clean emg and only twitches...odd
And you can't feel fibrillations in your tongue
 
No i have not been diagnosed with ALS as yet. Are you sure that you can't feel fibrillations in the tongue? I have something like pins and needles on the left side of my tongue.
 
Tim, I don't think you are going to get that diagnosed.
I asked my neuro about that, you can't feel fibrillations.
Pins and needles on tongue , I've had that too and mentioned that to my neuro = anxiety

Last couple of days I'm doubting my BFS diagnosed again as I have real wrist and thumb pain and so I drop a lot of things
 
Bart1, thanks a lot, you help me feeling better!
And i hope you're right i will not get that diagnosed.
 
Hi,
since a few days my tongue feels odd and i have tooth marks on the one side of my tongue. Is it possible to feel the fibrillation in the tongue? And is it possible to have twitches all over the body (also face) and bulbar onset?
Thanks, Tim

teeth marks...
 
You already got a diagnosis . . . NEUROPATHY . . . and your EMG is absolutely consistent with that, which is again why you got a diagnosis of . . . NEUROPATHY! A neuropathy IS NOT ALS, so I'm not sure where you read that. Relax!
 
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