47 y/o Male, Recent Abnormal EMG With Questions

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Mar 2, 2024
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I don't take posting here lightly at all as I know many of you have been deeply pained by ALS (my grandfather passed due to Parkinsons) but I am concerned. I absoultely and a believer in following what your Dr (trained professionals are saying) but want a second thought from folks who have gone through this extensively.

I thank you all for listening and providing any POV that you might have. Very much appreciated!

- For 2 1/2 years I've had progressing pain throughout my muscles in my body and progressing very obvious muscle twitching in both legs & even (in additional to muscle pain) in my arms. Upon recent exam by neuro, they saw no clinical weakness in any of my limbs or muscle wasting.
- I have seen most every specialist at this point (Neuro, Rheum, Allergist, etc) and no one has been able to isolate really anything that could be going on
- I have had an MRI of my cervical spine (not lumbar spine)
- I have had slightly increased CPK levels (~300-400) in the past
- I had an EMG about 2 years ago that showed I had mononeuropathy of my left peroneal nerve and no other irregularities were shown
- I had an EMG last week and I'm including the findings below. Unlike the previous note, they only did the nerve conduction test in both legs and only muscle testing in my left leg. The right leg showed no nerve irregularities.

My concerns here are:
- the continued and progressing pain throughout the muscles in m body (legs/arms/neck)
- the recent EMG in my left leg showing that I had fibrillations (my understanding is there is a difference on EMG with a fasciculation and fibrillation) with abnormal spontaneous activity; aren't these concerning taken with the body wide muscle pain along with the obvious twitching in my leg?
- In addition to the conclusion of the below, my Dr. emailed me saying that I had a pinched nerve somewhere between my knee/ankle and they've ordered an MRI Neurography of my left leg; his working theory is that I have scar tissue or injury to the nerve.

- Should I be concerned about getting another opinion? The fibrilations on EMG, the abnormal spontaneous activity & pain throughout the muscles in my body.. should those be of deeper concern?
- When he says "injury to the nerve" could that be something along the lines of a MND?
- Lastly - do EMGs that look at a left leg nerve/muscle along with right leg nerve issue... would they be able to distinctly tell this isn't some more nefarious MND situation?

EMG Summary TableSpontaneous MUAP RecruitmentMuscle IA Fasc Other PSW Fib Amp Dur. Polyph Pattern Activat OtherL. Tibialis anterior N None None 2+ 0 N N N N Full NL. Tibialis posterior N None None 1+ 0 1+ N N Mod Red Full NL. Gastrocnemius (Medial head) N None None 0 0 N N N N Full NL. Peroneus longus N None None 3+ 0 2+ N N Mod Red Full NL. Extensor hallucis longus N None None 0 0 N N N N Full NL. Vastus medialis N None None 0 0 N N N N Full NL. Biceps femoris (short head) N None None 0 0 N N N N Full NL. Lumbar paraspinals (low) N None None 0 0 No Relaxation

Needle EMG from a select population of muscles in the left L2-S2 myotomesusing a disposable monopolar needle electrode revealed abnormalspontaneous activity in the left tibialis anterior, tibialis posterior,peroneus longus. Motor unit analysis revealed motor units with increasedamplitude in left tibialis posterior and peroneus longus with decreasedrecruitment in these groups as well. Lumbar paraspinals unobtainable givenpoor relaxation.

Conclusion:Today's study is abnormal.There is electrodiagnostic evidence of left commeon peroneal neuropathy )distal to the knee, moderate in severity, with some ongoing denervation.There was no noted slowing across the fibular head.There is also evidence suggestive of left L5 radiculopathy.Recommend further imaging of left leg to evaluate the course of peronealnerve.Patient may also benefit from imaging of the lumbar spine

No clinical atrophy or weakness is really the key here, as regards ALS.

The action steps seem on point to me. Definitely have the lumbar MRI as that can provide not only a more precise diagnosis but a justification for reimbursement of PT, which you could probably benefit from. Besides therapeutic exercise, PT can help you with daily positioning and ergonomics.

Meanwhile, I'd suggest monitoring your sitting/slumping posture and trying not to trap/pressure your L leg in particular but with diffuse pain and possible radiculopathy, keeping your spine neutral no matter what you are doing can only help. That means stuff like feet on the floor, knees at a right angle, pretend your head is being pulled to the ceiling.

I see no reason to worry about ALS. But diffuse pain, besides being related to spine damage and possibly the scar tissue they hypothesize, often closely tracks poor sleep, hit/miss nutrition, stress, binges of one kind or another, things like that. I don't mean "it's all in your mind," but that neurotransmitters related to stressing out your body can have very real physical effects.

So chilling out your life as much as possible and focusing on posture/breathing in your case could have major dividends.
Thanks so much for your note above - very much appreciated!
My concern was on the fibrillations noted/abnormal spontaneous activity etc & continued all-over muscle pain/twitching.
Spontaneous activity is only concerning for ALS if it's paired up with EMG findings that yours fortunately didn't show. And all-over muscle pain/twitching argues strongly against ALS, which by definition can't show up everywhere at once.
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