3 Clean EMG's Can this all be UMN?... LMN?.... PLS?

[Zaphoon]

Thanks, Caroline!

Maybe I've reached the limit on receiving "likes" or perhaps in order for me to receive any more, I need to give more. After all, it is more blessed to give than to receive!:wink:

 

[olly]

the like buttons turned up,thanks for your pz

 

[curtrill]

Notme,

Sorry to hear what all you're going through. I really appreciate your time in responding. May I ask how your symptoms initially presented and how long you been having trouble?

Fibromialgia was ruled out by physical exam a certain pressure points that are painful to patients with fibromialgia. I tested negative to all these pressure points.

Not sure if the loss of tone in my calves and legs would be considered hypotonia. Perhaps hypotonia is something altogether different. My leg muscles have become very flaccid but feel tight When I stand or am walking.

 

[curtrill]

Fibromialgia was ruled out by checking certain pressure points. I had no pain at any of the trigger pimput.

I don't know that what is going on with my muscles is hypotonia. I can contract and release my muscles fine. That's one of the issues I was hoping to get some clarification on. Didn't know whether or not this sounds like something that would show up on the emg or if it sounded like pure UMN symptoms. Thanks for everyone's continued input.

 

[notme]

Notme,

Sorry to hear what all you're going through. I really appreciate your time in responding. May I ask how your symptoms initially presented and how long you been having trouble?

Fibromialgia was ruled out by physical exam a certain pressure points that are painful to patients with fibromialgia. I tested negative to all these pressure points.

Not sure if the loss of tone in my calves and legs would be considered hypotonia. Perhaps hypotonia is something altogether different. My leg muscles have become very flaccid but feel tight When I stand or am walking.

I'm apparently wrong, curtrill. I don't have any flaccid muscles in my legs at all--not even my previously flabby thighs. They are always as tense as can be--sitting or standing or walking.

My issues started a little more than a year ago. Left arm to right arm to legs. My legs are very weak. I can't stand without something to pull myself up on. If I fall--I can't get back up--and I fall a lot.

I edited my first reply--I didn't know you had flaccid muscles with UMN issues--which is why I said others are much more knowledgeable.

 

[susanf]

I'm a newbie here but if my neuro gave me clean emg's x 2 I would have given him the biggest kiss, left the office and NEVER given ALS a second thought for the rest of my life.
Enjoy life and stop worrying!

 

[curtrill]

Does anyone know if an asymmetrical presentation occurs in UMN or PLS? Or is it present only in LMN onset?

 

[curtrill]

Olly,

The reason the tongue was EMG'ed is because of its'appearence and my complaints of fatigue at the base of the tongue while eating. Additionally, upon my first exam at the ALS Center a nurse practicioner noted. what she thought to be tongue fasics. She ordered the tongue to be tested on the second EMG. For whatever reason it wasn't done. No fasics have been noted by the neuro I am seeing now in about three clinical exams.

 

[curtrill]

Olly,

The reason the tongue was EMG'ed is because of its'appearence and my complaints of fatigue at the base of the tongue while eating. Additionally, upon my first exam at the ALS Center a nurse practicioner noted. what she thought to be tongue fasics. She ordered the tongue to be tested on the second EMG. For whatever reason it wasn't done. No fasics have been noted by the neuro I am seeing now in about three clinical exams.

 

[trfogey]

He did the tongue on the last EMG through one stick under the chin not in the tongue. Any opinions on this method and does it rule out UMN and or PLS? I have read on some places on this site that it does and other places it is LMN.....? Can both be true?

Curtrill,

How many places would you need to grab a bare wire to determine whether an electrical current was flowing in it?. That's what an EMG does -- it determines whether there is current flowing from your LMNs (in the spinal cord) to the muscles they control. If the circuit is good at the far end (the muscle), it's good at the points in between.

When they stuck the EMG needle in under your chin, they were testing the circuit between the LMN in the upper (bulbar) portion of the spinal cord and and the muscles at the base of your tongue and the upper front portion of your throat. If your EMG was clean, the LMNs controlling those muscles are fine.

There is no comparable test for UMNs unless you want them to take the top of your skull off and poke around with needles in the motor cortex of your brain, since that's where your UMNs live. Your clinical exams have been clean for UMN signs, though, so no need for such extreme procedures exists, fortunately.

 

[awieleba]

cutrill,

I understand your concern. I have the floppy muscle tone in legs, and all over muscle loss. I even as well had atrophy noted by doc in shin but when emg'd was fine, same with hands and a large dent in forearm that was clear.My hands, they are thinned and hurt, have hard time doing things and email these days. Have execise intolerance, well at this point any and all intolerance! I can tell you this......try to relax. I am 3+ years into this. I have went to the als univeristy for 3 yrs with an emg every year (I have had about 6) and muscle biopsy, mri's, etc. AND no answer. I have the same reflexes (normal, with exception of symentrical brisk 2+ at knees) as you but I did have a + jaw jerk and I have many small lesions on brian mri that are not thought to be MS. I switched to a MDA clinic and seeing a new doc and he suspects or is looking into adult on set MITOchondrial disease at this point. He said NO to ALS after all these years and clean emg.I have no real UMN sx either except jaw jerk. I want to tell you that I know you are scared but there are so many other muscle disorders out there other than MND. I have hard time with the wait and see as well but that is what a lot of us are. there are a lot of people I met on this very web site 3 years ago with the same symptoms as me (and others on this part of forum) that still have issue's but no answer. I am not doing better and in some ways worse than 3 yrs ago, but I just want you to know that there are people out here that have your symptoms and 3 years down the road have not got an als diagnosis. I know this is a hard time, believe me.. I get it. Blessings to you.

 

[olly]

During voluntary movement, the nervous system normally regulates the strength of muscle contraction by modulating the number of active motor neurons and their firing rates. Stronger contractions are normally produced both by increasing the firing rate of active motor neurons and by recruiting inactive motor neurons
After injury to the motor cortex or the corticospinal tract in humans, voluntary movements become slow and effortful, and recruitment and firing rates of motor units are reduced
This reduced ability to activate motor neurons is generally attributed to the loss of descending excitatory input. However, chronic loss of corticospinal input may also produce adaptations in spinal neurons or afferents. For example, the hyperactive stretch reflexes that develop after injury to the corticospinal tract are associated with reduced presynaptic inhibition and reduced postactivation depression of Ia spindle afferents
Only a few studies have addressed whether spinal motor neurons undergo changes in excitability after loss of corticospinal inputs. In acute spinal injury, the flaccid paralysis and reduced stretch reflexes of spinal shock have been attributed, in part, to transient hypo-excitability of motor neurons
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i did find one article in g**gle books but it wont let me copy and paste.
other deseases that do manifest spasticity with hypotonia are mitochondrial deseases and cerebal palsy.

 

[olly]

Upper motor neuron system hypotonia refers to hypotonia that occurs as a consequence of disorders of the neurons that directly or indirectly make contact with the lower motor neurons. Upper motor neuron system hypotonia occurs with diseases of the brain, cerebellum, brainstem, and spinal cord
Hypotonia due to upper motor neuron system lesions may be associated with decreased dynamic tone or increased dynamic tone. Upper motor neuron system dysfunction is often associated with clinical findings that reflect the involvement of neighboring neurological and nonneurological structures. Upper motor neuron system hypotonia is not associated with any specific electromyographic, nerve conduction velocity, repetitive stimulation test, or muscle biopsy abnormalities unless there is simultaneous involvement of the alpha motor neurons and the muscle fibers (motor-sensory unit
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Injury of upper motor neurons is common because of the large amount of cortex occupied by the motor areas, and because motor pathways extend all the way from the cerebral cortex to the lower end of the spinal cord. Damage to the descending motor pathways anywhere along this trajectory gives rise to a set of symptoms called the upper motor neuron syndrome.
This initial period of “hypotonia” after upper motor neuron injury is called spinal shock, and reflects the decreased activity of spinal circuits suddenly deprived of input from the motor cortex and brainstem.
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). As already discussed, isolated lesions of the lateral cor- ticospinal (pyramidal) tract in monkeys do not pro- duce spasticity but rather hypotonia, hyporeflexia and loss of cutaneous reflexes. Extending the lesion to involve more of the lateral funiculus (and hence the dorsal reticulospinal tract) results in spastic- ity and tendon hyperreflexia (Brown, 1994). Sim- ilar lesions in man of the dorsal half of the lat- eral funiculus produced similar results
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[curtrill]

Awieleba,

Thanks for your kind words and encouragement. Sorry you're having troubles as well. Prayerfully we will both get some answers soon and our health will be restored. Blessings to you also!

 

[Bhappy]

Just a quick thought - every time I see clean/dirty emg notes, it flashes me back to last summer. I was told, "You have an abnormal emg," on the phone by a nurse. It took 2 more abnormal emgs to yield this diagnosis. Hence every time I see "clean emg" I get a tinge of pure jealousy since those words have never been spoken to me.