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MLane

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Is it possible for EMGs to be done too early to detect anything. I am a nurse and have done extensive research on Neuromuscular disorders. I have had undesirable symptoms (mainly right sided) for about 13 months now. I have experienced classic Als symptoms (stiffness, twitches (in ominous places), weakness, and what appears to like atrophy (right sided again). At any rate, I have had 3 EMG/NCV tests done (one at Mayo clinic in Jacksonville). The only one that showed anything was the one at Mayo on July 31,2012 which was a borderline result in my right ankle. Anyway, again my question is can EMG/NCVs be done too early to detect anything & can Clonazepam mask results as I have been taking it for a year. The Clonazepam definitely does something to the muscles because the pain is less and they seem stronger after a dose, for that small window of the drug's peak strength. The small inner circle I have included in this assume all is well because there hasn't been any remarkable results on any of the tests. But none of them have any medical background and sometimes results will not manifest until a certain level of disease is reached, such is the case with HIV where there is a few month window after infection before a standard blood test will detect the virus. I would be most grateful for any input.
 
Mlane
There is another post here, that I have just responded to that addresses this to some degree.

I have MND, my EMG showed abnormalities in January, before any other clinical signs of weakness (I still don't have clinical weakness on the score they used only last week).

I am not a specialist and maybe others will jump in but have a search around here.

Warm regards and welcome.

Ian
 
I am not the EMG expert but I would have thought that it would show any changes potentially long before other symptoms develop, certainly in my case.

I want to use an example I think has previously been used. Just because you have a clean EMG now, doesn't preclude you from developing ALS / MND later on. No more than a scan today that says you don't have cancer doesn't mean at some point in the future you won't get cancer.

If your emg is clean now, rejoice, live life and get on with it. Doesnt mean that you will not develop MND in the future as per much example. Live your life now, enjoy each and every day. But for goodness sake just live it while you can.

Something that all of us living with this condition do anyway.

I wish you well
Ian
 
Thank u Ian for your kind & informative response. I guess I'm just scared. While I would obviously be very devastated to be diagnosed with MND personally, I think I worry more about how others would be impacted should a diagnosis come one day. I wish were more definitive tests for such disorders. The waiting game is both a blessing & a curse! Thanks again for your response.
 
And unlike others, I had weakness for 2 years before the EMG was definitive. The ALS clinic had a probable diagnosis in 2009, but the EMG September 2011 make diagnosis definitive.
 
MLane

Waiting is by far the hardest part, until diagnosis that is, then your definition of hardness changes on a daily basis.
Being scared of a potential diagnosis is understandable, I remember my past few months being full of fear and emotion.

I only received my diagnosis on 10 September this year, so it is very real, raw and fresh.

Firstly I lived in denial and looked for every other option, now I live with acceptance, that I can't change it, I didn't choose it, and that I have all the hope and faith in the world that a cure will be found in my lifetime.

Those around you will adapt, sure it must be incredibly hard on them, but it is incredibly difficult to live with a life limiting illness.

We are all strong beings, we can generally adapt to adversity as we look at it in the face. As a couple, we don't spend a lot of time worrying about tomorrow but living for today and making fond memories each and every day for me to cherish until my demise and for my loved ones to hang onto for many years there after. It is never going to be easy but we live One Day at a Time.

I feel robbed of our future plans, not being able to provide for my family, but my diagnosis is a slow progressing form, and I plan on realising as many dreams and aspirations as possible before this disease robs me of that ability.

I wish you well

Warmest regards

Ian
 
What do you mean by borderline results in the ankle? There is a classic pattern seen in ALS on the EMG. While some that present with UMN issues first may have clear EMGS, for a while, they have clinical chances on exam.

The majority have changes on the EMG in their checks months before some of those area show any weakness. Have they ruled out other causes of your ome sided weakness such as stroke?
 
Notme, The results of the R ankle portion of the NCV @ Mayo were outside of normal bracket, but barely. I guess a stroke could be possible, but onset usually sudden.
 
I'm not sure if it can be done too early, in my case I had the EMG very early on. I had just started with the neurologist & had only minor symptoms. The EMG came back as abnormal, no diagnosis was made as a result of this result. It is just one of the many tests that you will have. Be grateful if the results are anything other than abnormal.
 
I go for my 3rd EMG tomorrow. However it is the first one to be done @ Duke University Hospital. My weakness started in my neck back in January. My right leg started buckling in June. Now I have to walk with a walker and have been on disability for 4 months. Still, my first 2 EMGs were clear. I have yet to be diagnosed but I continue to get weaker. My right side is now noticably smaller than my left even though I am right handed and still eat with my right.
 
Notme, The results of the R ankle portion of the NCV @ Mayo were outside of normal bracket, but barely. I guess a stroke could be possible, but onset usually sudden.

The NCV is normal in ALS, which is a good sign.

Try to think positive. An abnormal MCV is a good thing when ALS is on the table.

Edit to add, if you had a MND severe enough to have caused atrophy, the EMG would MOT be normal. I think you're looking in the wrong area for a diagnosis.

ALS, as you know, normally either starts distally in one limb (a hand or a foot) or with bulbar symptoms) and as you know as a nurse, a left sided stroke would cause right sided symptoms...but LEFT sided facial symptoms.

Do you have any clinical weakness? In ALS there are no meds that make weakness better...none. Though there are meds that can make some UMN signs such as spasticity and such better, but those aren't the signs that show on the EMG.

Have you had a neck MRI? Are you sure you haven't injured a disc? How bout a brain MRI to rule out MS.

UMN signs show pretty clearly on an exam, with abnormal reflexes and spasticity being the most common, and cramping the first thing you'd have likely noticed.

ALS isn't usually considered 'paimful' I'm early stages unless there is severe spasticity.
 
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Notme, had MRI of head & neck fall of 2011; both normal. I hope your right & I'm just barking up the wrong tree. Thx for the input.
 
My husband's first EMG was done by an area neuro, but he said it was clean. Less than 2 months later, the Vanderbilt ALS Clinic did a much longer, more thorough EMG and he was diagnosed with ALS after a long clinical exam, NCV, and EMG. I also found out that when the EMG is being done the patient must be asked to engage their muscles so the doctor can see the muscle at action and not in action. The first nuero never once asked him to engage his muscles. The local doc also did a NCV and diagnosed carpal tunnel syndrome. My hubby also was recommended for neck surgery which he had, and was about to have double carpal tunnel syndrome surgery when the docs at Vandy said there was no carpal tunnel at all!
 
My husband's first EMG was done by an area neuro, but he said it was clean. Less than 2 months later, the Vanderbilt ALS Clinic did a much longer, more thorough EMG and he was diagnosed with ALS after a long clinical exam, NCV, and EMG. I also found out that when the EMG is being done the patient must be asked to engage their muscles so the doctor can see the muscle at action and not in action. The first nuero never once asked him to engage his muscles. The local doc also did a NCV and diagnosed carpal tunnel syndrome. My hubby also was recommended for neck surgery which he had, and was about to have double carpal tunnel syndrome surgery when the docs at Vandy said there was no carpal tunnel at all!
That is scary to think of, always thought a clean EMG was a good thing from the get go. Well, now it seems differently per Alabama Gal.
 
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Yep, shouldn't have read that one. *facepalm*
 
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