Unread 03-16-2013, 02:03 PM #1 (permalink)
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Default How accurate are EMG's?

I have been going through an ALS diagnosis for over a year now. 6 months ago I was classified as 'possible' ALS (stage 1) and after a follow up last thursday with my neurologist which included my fourth EMG I was shocked to hear him tell me that I was now going to be classified as 'probable' ALS, which according to him is means I'm 90% diagnosed with ALS (as in 90% of people classified as 'probable' eventually are diagnosed as 'definite'.)

The reason I was shocked was because I have not felt any changes whatsoever in the last six months, my legs feel fine, my left arm feels fine. The only symptom I have other than my right arm issues is bodywide twitching, which I have had since last summer. He seems to have based this decision soley on the EMG that was done. So I'm just wondering if there are any hard numbers, statistics, etc, showing the accuracy of EMG's. Any help is much appreciated.
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Unread 03-16-2013, 03:13 PM #2 (permalink)
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Default Re: How accurate are EMG's?

A well done and read EMG can detect and pick up abnormalities going on with your Motor Nervous System even before you start noticing anything wrong going on.

In your case, however, I cannot tell anything since I'm not a Neurologist nor have experience dealing with medical issues and/or records.

But, if you have the results of the EMG run on you, you can contact a user here nicknamed "Wright" by PM, who happens to have very good insight interpreting the results from EMGs.

HTH

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Unread 03-16-2013, 06:08 PM #3 (permalink)
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Default Re: How accurate are EMG's?

Thanks Nighthawk, I don't have a copy of my latest EMG but I will try to get one. I was of the understanding that weakness typically came first before an EMG would show much, is that wrong? I know the very first EMG didn't show hardly anything at all and yet I had already lost 50% of the strength in my grip and had started to atrophy.
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Unread 03-16-2013, 07:15 PM #4 (permalink)
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Default Re: How accurate are EMG's?

EMGs are usually designed to pick up serious ongoing conditions that might be affecting your motor nerves, peripheral nerves or sensory nerves.

For example, if the technician who ran the EMG on you detected: "Chronic Denervation" ongoing (I don't know for certain what yours says, I am just giving you an example), that means that something is messing up with, let's say your motor nerves and is targeting the motor neurons selectively for destruction which leads to weakness, muscle twitching and ultimately atrophy, in that order.

But, it might be many things, from MMN to CIDP to ALS.
But in the end, is the Neuromuscular physician the authorized person to request more tests in case he deems them necessary and to interpret the meaning of your EMG results to make the right diagnosis.

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Unread 03-17-2013, 12:56 PM #5 (permalink)
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Default Re: How accurate are EMG's?

In my case, one-sided weakness and fasciculations prompted the first EMG, but the EMG detected mild changes in my "good" arm months before I noticed physical weakness and loss of dexterity in that arm.

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Unread 03-17-2013, 01:17 PM #6 (permalink)
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Default Re: How accurate are EMG's?

my first emg detected abnormal in both arms, back, and left leg. at that point my left hand strength was 1/2 that of right hand and i had not noticed any problem in right hand or left leg, of course after 3 1/2 years its noticable
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Unread 03-17-2013, 02:08 PM #7 (permalink)
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Default Re: How accurate are EMG's?

In my case the EMG was very accurate. I had 17 falls before my neurologists decided to order an EMG. One of them had previously told me I did not have ALS. He did the EMG and changed his mind. Meanwhile, I had gone to an ALS clinic where the EMG was repeated. It showed damage to the motor neurons in both legs. I previously had received the diagnosis of foot drop, which is a symptom of ALS, according to the Mayo Clinic.

I knew I had ALS before the EMGs, because my mother and my aunt had it before me, and they had the same symptoms.

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Unread 03-21-2013, 08:25 AM #8 (permalink)
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Default Re: How accurate are EMG's?

I guess i am wondering the same. For the moment at least I am hoping that they are wrong. My father was diagnosed with ALS on 19th Feb following an EMG (where the results are pasted on this forum). I chucked every single disease i could back to the neuro and he said definitely not any of those. My father has atrophy in both arm muscles , cant lift them above his head, a slight curl in his left hand and a thicker voice.
No fascilations or twitching whatsoever and in the last 6 months this is all that has happened.
I am deeply wondering if my father has ALS now. But I would rather accept ALS than not and then later get the shock of my life. So having started taking St Johns Wort for a month now I am seeing the glass half full. We are trying to do whatever we can to stop the disease in its tracks and we’re keeping a journal for any noted changes.
So at the moment, hes on a heap of vitamins prescribed by myself and some homeopathy tablets prescribed by my Indian homeopath and hes have neurophysio done every day for the past 8 days. He will be in India until end of April at the min and I will document any changes on my own thread. The doctor there believes that ALS can be slowed in its tracks if not stopped but certainly not reversed. So we shall see.

but I guess this disease shows its colours in full throttle. I dont believe EMGs are Gods words to diagnose a disease.
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Unread 03-23-2013, 09:14 PM #9 (permalink)
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Default Re: How accurate are EMG's?

I spent 18 months and three EMGs that didn't show ALS. The wife and I figured that's what it was though. My body finally showed ALS symptoms at EMG 4 at 18 months. Prior to that, just drop foot and a diagnosis of peripheral neropathy
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Unread 03-23-2013, 10:09 PM #10 (permalink)
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Default Re: How accurate are EMG's?

emg #1, neuro 1 said i suspect als, emg #2 neuro 2 not sure, recommended als clinic, emg #3 neuro's 3 & 4 said sorry you have als with problems in back, both arms and left leg. only left arm and hand was noticeable to me. emg #4 neuro 5 confirmed als (va did not accept first diagnoses) als may be in areas you are unaware of but results of emg's in my case were positive. now if could only fine a way to stop or slow the constant ticking of the clock. my wife (caregiver) and i get out everyday, visit friends, family, pals, go to gym, eat out. doing something everyday helps and gives you something to look forward to
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Unread 03-23-2013, 11:23 PM #11 (permalink)
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Default Re: How accurate are EMG's?

For an ALS diagnosis I thought that the hallmark signs are the fasciculation, which are twitches. Along with an abnormal neurological exam. My grandpa did not have an abnormal EMG, but when I asked the dr why they were so sure they said because of the twitching and the abnormal reflexes. Did you get the full evaluation?

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Unread 03-24-2013, 12:12 AM #12 (permalink)
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Default Re: How accurate are EMG's?

I call the "clinical diagnosis"...the "diagnosis by the textbooks" because it's the one the Neuros use to determine damage to the UMN (Upper Motor Neurons, the ones in the brainstem). They do not need EMGs, or any special and expensive equipment, to do that.
Just by having hyperreflexia (brisk reflexes), clonus, spasticity, Babinski sign, etc., they can easily determine you have some sort of damage to your UMN.
If that happens...SIMULTANEOUSLY with a "dirty" EMG coupled with fasciculations and muscle atrophy...then you get the diagnosis of ALS.

If it starts just as pure LMN (Lower Motor Neurons) damage...it gets tricky, because at the beginning, there other diseases that mimic ALS (manifesting only as LMN) and may also cause fasciculations and muscle atrophy. That's why with only LMN damage, your definite diagnosis might take a little bit longer until they can rule out any other diseases that might mimic ALS.

If at the beginning, you exclusively have UMN damage, then you get diagnosed PLS (Primary Lateral Esclerosis).


HTH

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Unread 03-25-2013, 12:11 AM #13 (permalink)
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Default Re: How accurate are EMG's?

Well I have fasiculations, weakness, atropy, cramping & dirty EMG's so I guess that's that. It's just weird that everything else feels fine other than my right arm/hand - and even that isn't so bad, I can still lift things over my head, type, shake hands, etc... nothing left to do now but wait & see.
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Unread 03-25-2013, 03:00 AM #14 (permalink)
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Default Re: How accurate are EMG's?

Quote:
Originally Posted by Amber10 View Post
For an ALS diagnosis I thought that the hallmark signs are the fasciculation, which are twitches. Along with an abnormal neurological exam. My grandpa did not have an abnormal EMG, but when I asked the dr why they were so sure they said because of the twitching and the abnormal reflexes. Did you get the full evaluation?

Amber
Sorry--but this is NOT necessarily true. I've got abnormal reflexes, clinical exam, atrophy, and fasciculations noted by my neurologist--and I do not have a definite ALS diagnosis.

Quote:
Just by having hyperreflexia (brisk reflexes), clonus, spasticity, Babinski sign, etc., they can easily determine you have some sort of damage to your UMN.
If that happens...SIMULTANEOUSLY with a "dirty" EMG coupled with fasciculations and muscle atrophy...then you get the diagnosis of ALS.
Not always--at least not in my cause. I'm still "possible" or "probable' depending on who you ask.
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Unread 03-25-2013, 05:22 AM #15 (permalink)
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Default Re: How accurate are EMG's?

Unlike medical tests, EMGs are very operator variable. My final EMG was with the assistant director of the ALS clinic with three advanced certifications in the technology. By that time I had symptomatic for three years albeit slow progressing. Hope this helps
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