Tony292
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I cant make sense of most of this, I am NOT of any sort of medical background whatsoever, I would appreciate any translation or thoughts on what it means in laymans terms:
Electromyography:
Left tibialis anterior (L4,5,deep peroneal n.): Normal insertional activity, no spontaneous activity.
50% complex, mildly unstable, mildly increased duration motor unit potentials. Normal recruitment, full
interference pattern.
Left medial gastrocnemius (S1,2,tibial n.): Increased insertional activity, no spontaneous activity.
Normal motor unit potentials. Normal recruitment, full interference pattern.
Left vastus lateralis (L2,3,4,femoral n.): Normal insertional activity, no spontaneous activity.
Normal motor unit potentials. Normal recruitment, full interference pattern.
Left lumbosacral paraspinals (L3/4, L5/S1): Normal insertional activity, no spontaneous activity.
Left thoracic paraspinals (T7/8): Increased insertional activity, no spontaneous activity.
Left thoracic paraspinals (T6/7): Normal insertional activity, no spontaneous activity.
Left first dorsal interosseous (C8,T1,ulnar n.): Normal insertional activity, 2+ complex
fasciculation potentials. 25% complex, mildly unstable, mildly increased duration motor unit potentials.
Normal recruitment, full interference pattern.
Left deltoid (C5,6,axillary n.): Normal insertional activity, no spontaneous activity. 25% complex,
stable motor unit potentials. Normal recruitment, full interference pattern.
Left trapezius (accessory,C3,4), left genioglossus (hypoglossal n.): Normal insertional activity, no
spontaneous activity. Normal motor unit potentials. Normal recruitment, full interference pattern.
Summary:
NCS: All studies were performed at a limb temperature of greater than 32 degrees Celsius. The
left peroneal motor response and F-waves were normal. The left tibial motor response and F-waves were
normal with A-waves noted at 25.0 and 39.6 msec. The left sural and superficial peroneal sensory
responses were normal.
RNS: The cramp protocol was used with supramaximal stimulation of the left tibial nerve
recording over the left abductor hallucis. A train of 5 stimulations at 1Hz was administered followed by 5
at 5Hz and 10 at 10Hz. No afterdischarges, electrophysiologic cramps, or clinical cramps were noted.
EMG: Concentric needle EMG was performed of selected muscles in the left lower extremity, left
lumbosacral paraspinal musculature, left thoracic paraspinal musculature, left upper extremity, and left
cranial musculature. The study was remarkable for evidence of a very mild though widespread motor
axonopathy affecting the left upper and lower extremities, sparing the cranial musculature, with evidence
of only mild muscle membrane instability in the thoracic paraspinal musculature.
SFEMG: Jitter analysis was performed of the left frontalis using a 25mm 30g concentric needle
electrode. 20 fiber pairs were examined in the left frontalis with a mean MCD of 29.0msec (age-matched
single fiber normal < 35.5msec1). 5% of fiber pairs examined demonstrated abnormal jitter; the
remaining 95% were normal (age-matched single fiber normal < 53.5msec1). Of note, the fiber pain
demonstrating abnormal jitter was contained within a triplet; jitter was normal between the other two fiber
pairs in the triplet.
1. Bromberg MB, Scott DM, et al. Single fiber EMG reference values: reformatted in tabular form. Muscle Nerve
1994;17:820-1.
Conclusion:
This is an abnormal study. There is electrophysiologic evidence of a mild though widespread motor
axonopathy with involvement of the cervical and lumbosacral regions on the left. Evidence of muscle
membrane instability was noted in the left thoracic paraspinal musculature without overt denervation.
Given the waveform characteristics, the borderline abnormal single fiber EMG was likely a false positive
secondary to the noted motor axonopathy; as such, though findings on concentric needle
electromyography of the cranial musculature (trapezius, genioglossus) were normal, the findings are
suggestive of a subtle motor axonopathy affecting the cranial musculature as well.
As such, the constellation of findings approaches though does not clearly meet the lower motor neuron
portion of the El Escorial criteria for motor neuron disease. Clinical correlation is recommended;
recommended repeat electrodiagnostic testing in 3 to 6 months.
Electromyography:
Left tibialis anterior (L4,5,deep peroneal n.): Normal insertional activity, no spontaneous activity.
50% complex, mildly unstable, mildly increased duration motor unit potentials. Normal recruitment, full
interference pattern.
Left medial gastrocnemius (S1,2,tibial n.): Increased insertional activity, no spontaneous activity.
Normal motor unit potentials. Normal recruitment, full interference pattern.
Left vastus lateralis (L2,3,4,femoral n.): Normal insertional activity, no spontaneous activity.
Normal motor unit potentials. Normal recruitment, full interference pattern.
Left lumbosacral paraspinals (L3/4, L5/S1): Normal insertional activity, no spontaneous activity.
Left thoracic paraspinals (T7/8): Increased insertional activity, no spontaneous activity.
Left thoracic paraspinals (T6/7): Normal insertional activity, no spontaneous activity.
Left first dorsal interosseous (C8,T1,ulnar n.): Normal insertional activity, 2+ complex
fasciculation potentials. 25% complex, mildly unstable, mildly increased duration motor unit potentials.
Normal recruitment, full interference pattern.
Left deltoid (C5,6,axillary n.): Normal insertional activity, no spontaneous activity. 25% complex,
stable motor unit potentials. Normal recruitment, full interference pattern.
Left trapezius (accessory,C3,4), left genioglossus (hypoglossal n.): Normal insertional activity, no
spontaneous activity. Normal motor unit potentials. Normal recruitment, full interference pattern.
Summary:
NCS: All studies were performed at a limb temperature of greater than 32 degrees Celsius. The
left peroneal motor response and F-waves were normal. The left tibial motor response and F-waves were
normal with A-waves noted at 25.0 and 39.6 msec. The left sural and superficial peroneal sensory
responses were normal.
RNS: The cramp protocol was used with supramaximal stimulation of the left tibial nerve
recording over the left abductor hallucis. A train of 5 stimulations at 1Hz was administered followed by 5
at 5Hz and 10 at 10Hz. No afterdischarges, electrophysiologic cramps, or clinical cramps were noted.
EMG: Concentric needle EMG was performed of selected muscles in the left lower extremity, left
lumbosacral paraspinal musculature, left thoracic paraspinal musculature, left upper extremity, and left
cranial musculature. The study was remarkable for evidence of a very mild though widespread motor
axonopathy affecting the left upper and lower extremities, sparing the cranial musculature, with evidence
of only mild muscle membrane instability in the thoracic paraspinal musculature.
SFEMG: Jitter analysis was performed of the left frontalis using a 25mm 30g concentric needle
electrode. 20 fiber pairs were examined in the left frontalis with a mean MCD of 29.0msec (age-matched
single fiber normal < 35.5msec1). 5% of fiber pairs examined demonstrated abnormal jitter; the
remaining 95% were normal (age-matched single fiber normal < 53.5msec1). Of note, the fiber pain
demonstrating abnormal jitter was contained within a triplet; jitter was normal between the other two fiber
pairs in the triplet.
1. Bromberg MB, Scott DM, et al. Single fiber EMG reference values: reformatted in tabular form. Muscle Nerve
1994;17:820-1.
Conclusion:
This is an abnormal study. There is electrophysiologic evidence of a mild though widespread motor
axonopathy with involvement of the cervical and lumbosacral regions on the left. Evidence of muscle
membrane instability was noted in the left thoracic paraspinal musculature without overt denervation.
Given the waveform characteristics, the borderline abnormal single fiber EMG was likely a false positive
secondary to the noted motor axonopathy; as such, though findings on concentric needle
electromyography of the cranial musculature (trapezius, genioglossus) were normal, the findings are
suggestive of a subtle motor axonopathy affecting the cranial musculature as well.
As such, the constellation of findings approaches though does not clearly meet the lower motor neuron
portion of the El Escorial criteria for motor neuron disease. Clinical correlation is recommended;
recommended repeat electrodiagnostic testing in 3 to 6 months.