34 year old female with concerning symptoms - two EMG results included

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Houmom308

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Hi there to anyone who comes across this post. I will try to keep this succinct, including my history and posting two EMG results. I have read the stickies and am so thankful for anyone who could shed some light on the below. I am currently under the care of a neurologist but am not able to get in for an appointment for a few weeks as he is out of town. I am hoping you could kindly provide any insight based on my history and the EMG findings. I have two young children and am really terrified at this point about what could be going on.

Mid-July 2022: My PCP noticed my left eyelid drooping. A few days before this I had noticed increasingly blurry vision and noticed the droop myself, which my PCP confirmed before I even brought it up at our appointment. She sent me for a brain MRI which came back clean, and I was referred to a neurologist. She also ran tests for thyroid function, which came back normal. The only finding on the blood work she ran was a positive ANA of 1:160, homogeneous pattern, but no associated antibodies for Lupus, Sjogrens, etc. I have no clinical autoimmune diagnosis, just the positive ANA.

August 2022: I meet with the neurologist to discuss the ptosis. He suggests that it could be Myasthenia Gravis. I also report some symptoms of general fatigue, left arm and hand weakness, mild tingling in toes and across my back. He orders more MRIs of cervical, lumbar, and thoracic spine to check for MS. Also a chest MRI to look for thymoma. No findings on chest MRI besides some residual thymus tissue, which neurologist says is not an issue. The Thoracic MRI showed a 3.5 x 1.3 cm syrinx in the conus medullaris centered at T12. The neurologist called this an incidental finding, but it may explain some of the foot and back tingling. Here are the findings for the Cervical MRI.

CERVICAL MRI:
C5-C6: BRoad-based disc bulging with uncovertebral joint arthrosis. Mild spinal canal stenosis. Mild bilateral neural forminal stenosis. (summarized as "mild degenerative changes at C4-C5 and C5-C6).

I test negative for the ACHR and MUSK antibodies for Myasthenia Gravis, so he schedules me for a SFEMG of my left eye, which will take place October 10.
I also try Mestinon and a steroid (both at very low doses - 60 mg/day mestionon and 2mg prednisone per day) for 7 days. Not much changes and the neurologist says I can discontinue taking it.

Early September 2022:
I decide to see a hand doctor about the left hand weakness, as I'm also having some pain and mild swelling in my elbow and thinking it could be a trapped nerve. I have attached the report from the EMG and NCS ordered by the hand doctor. The hand doctor says further testing is required as there may be an issue with my neck, but does not explain any of this in laymans terms to me, and I cannot make sense of the report. Is anyone able to interpret these results?

Mid September 2022:
I go back to my PCP about the symptoms. I am also now having intermittent twitching in my right bicep, and sometimes my torso and calves/thighs. I also speak with her about the left arm and hand weakness. She orders an EMG with a neurologist of both arms. I am also prescribed 25mg of Lexapro for anxiety, which I have since been taking. Here is the EMG/NCS report from this neurologist:
Impression

Reason for study: Left eye lid ptosis with negative Ab testing. Now with right biceps twitching and left arm heaviness.


Nerve conduction summary:
1. Normal right median motor and bilateral median sensory nerve conductions.
2. Normal bilateral ulnar sensory nerve conductions.

EMG summary:
Normal EMG of both arms with benign appearing fasciculations in the right biceps.

Impression:
Normal study. No evidence of upper extremity entrapment neuropathy or cervical radiculopathy.
Benign fasciculations in the right biceps. No findings for motor neuro disease.

Since these appointments, I am now having some issues with a lumpy feeling at the back of my throat and feeling like I am having some issues swallowing and shortness of breath. I am frequently coughing and clearing my throat. This concerns me for bulbar onset, along with the new twitching. I have not actually choked on anything.

My questions for you all:
1. Does any of this point to bulbar onset, or another form of ALS? Taking into account my symptoms as well.
2. Does the attached EMG report point to anything that could indicate ALS?
3. Does the neurologist's EMG report clear me from ALS or does this not, as it didn't test my neck/bulbar area?

Thank you so much for your kind consideration and response. I am so thankful for the resources here and thank you so much for your time.

[report deleted pending redaction of personal info]
 
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I removed the report bc it has identifying information. You can redact that and repost if you wish. But the NCS/EMG are completely normal and yes, it does clear you of ALS, which would show multiple abnormalities irrespective of the areas tested. I would ask for a PT referral for your spine issues, with the objective of alleviating some of your symptoms. I would also consider counseling in addition to the Lexapro, to help you parse the ways in which your mind may be contributing to your perceived physical symptoms.

Best,
Laurie
 
I am so sorry I completely forgot to redact that info. Thank you so much Igelb, I'm so incredibly sorry for the loss of your loved one and thank you for taking the time to respond to me, and others on this forum.

I should have noted that the RNS portion of the EMG showed decrements, which I read can be associated with ALS, but also MG. Is the RNS portion of no significance? I have attached that there (no personal information included).

Will continue to work with the neurologist of course as it relates to MG or anything else they think could be going on, and I am planning to take your suggestion of getting counseling in addition to the medication.

Thank you again for taking time out of your day to respond, I am grateful.
 

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The RNS decrements are not ALS (or MG)-specific and require clinical correlation to determine their significance. I can't comment further than that. So yes, I would continue to work with the neurologist.
 
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