Clean EMG with ALS?

[patricia1]

Doctor told me emg will pick lower motor neuron problems. Sometimes people have problems in upper motor neurons and this kind of problems cannot be picked up by an emg and are just diagnosed by a clinical exam. Other times people have problems in bulbar area and an emg done in other places (like limbs for example) can be clean or not since the disease that starts in bulbar area will spread to another places but not in the beginning . Als is a disease in which you have problems in both upper and lower motor neurons so after these explanations I think a clean emg means no als but could not rule out all kinds of mnd.

I was told that clean EMG means no ALS .

Wright can explain why.

I don't want to get in trouble again .

 

[HelenL]

All I know is all my EMGs were dirty, even the one that had to take a needle large enough to stick in my butt... That one hurt! Alot.

I didn't have much in the way of an EMG in my arms, just a couple of testing points to find out there were issues.

 

[patricia1]

Learn the difference between El escorial criteria vs awaji criteria.

"3. Conclusions of the consensus conference
1. We reaffirm the general principles underlying the El
Escorial and Airlie House recommendations for the
diagnosis of ALS. These are set out in modified form
in Table 2. In particular, the importance of full nerve
conduction studies and conventional EMG in excluding
other diseases was recognised (Lambert, 1969; Behnia
and Kelly, 1991; Daube, 2000). It is important to keep
in mind that the clinical neurophysiological examination
is used in the diagnosis of ALS when the diagnosis is suspected
clinically – suggestive neurophysiological findings
are therefore not intended to stand alone, outside the
context of the clinical assessment.

2. We conclude that, since needle EMG is essentially an
extension of the clinical examination in detecting features
of denervation and reinnervation, the finding of
neurogenic EMG changes in a muscle should have the
same diagnostic significance as clinical features of neurogenic
change in an individual muscle. Thus, within a single
limb, we recommend that abnormalities required for
the diagnosis of ALS may be derived from either clinical
or neurophysiological study, thus constituting the
requirement for involved muscles as set out in the general
instructions (Table 2). This interpretation renders
redundant the category ‘‘Laboratory Supported Probable
ALS’’ (Table 2) and will facilitate earlier diagnosis since it will allow a limb to be classified as abnormal earlier
than if this decision is based on clinical or EMG criteria
alone. The essential change is thus to recognise a
neurogenic EMG abnormality (Table 1) as of equivalent
significance to the clinical abnormality. It is, nonetheless,
important to confirm that EMG evidence of neurogenic
abnormality is found in clinically weak muscles.

3. We recognise that muscles may show evidence of chronic
neurogenic change in the absence of fibs-sw. We therefore
propose that the presence of fasciculation potentials
(FPs) in a muscle identified as showing needle EMG features
of neurogenic change should serve as evidence of
ongoing denervation, equivalent in importance to fibssw.
This criterion would obviate the need for the often
difficult search for fibs-sw in patients with clinically evident
features of ALS; in particular, in cranial-innervated
muscles and muscles of normal bulk and strength. For
example, although Finsterer et al. (1998) recorded fibssw
in some patients in bulbar muscles, de Carvalho
et al. (1999) found no fibs-sw in bulbar muscles in 15
bulbar-onset patients; fibs-sw were found in limb muscle
in only 7 of these 15 patients. In addition, in 2 of 28
newly diagnosed upper limb onset ALS patients, fibssw
were absent in the weak upper limb."[/quote]


Thank you for clearing what l been saying .I would be the rare bird .lol

I found it to be a waiting game .Doctors don't like throwing that ALS word around until they see clinical evidence .

 

[TedH5]

My pleasure Patricia. I had posted something similar before but it kind of got glanced over. I was hoping it would not happen again.

 

[patricia1]

Vindicated at last .I probably was in that study in 99 lol. That was my first EMG

Your a sweetheart Ted

Bless you

Patricia

 

[nightwolf_mk]

Other thing I was told is that when you go for an emg the doctor who perform the test has to be very experienced in this kind of exam. When I went for my exam the neurologist gave me a list of some doctors who does this exam and are reliable and said to do with just one of then.

 

[rose]

Ted and Pat,

Yes, that was very interesting and sheds a lot of light on seeming inconsistencies. It is, in fact, one of the most significant posts I've read in quite a while.

Everyone needs to remember that its the whole picture that matters. I know I point this out frequently, but it bears repeating. There is no one single test that, if it is not normal, will mean the person has ALS. Keep in mind that even ominous sounding findings such as positive babinsky sign can be caused by low B12. Trust your doctor, and make sure testing is done by someone with experience.

 

[hjlindley]

I had symptoms in 2008, probable diagnosis in 2009 and my first dirty EMG 2011. Neuro didn't say anything until the emg was dirty, but the clinical signs were pretty clear. I am distal onset (hands and feet ) with no bulbar involvement to date.

 

[GKGK]

Reading this thread, it right to say clinical exams performed by a ALS specialist is more important than EMG in a diagnosis? The EMG would just confirm clinical findings but never ruled out ALS. Thats it?

 

[olly]

A dirty emg can be due to a whole host of conditions........so YES ,ITS THE WHOLE PICTURE.

 

[victor jara]

I had a clean emg and nerve study last july. I saw 2 neuro's who both didn't think I had als. However I continue to get muscle wasting in my feet now round the heel and my calf muscles have lost all their tone. While I can still walk reasonably well I get tired after about 600yds. Lose balance easily and trip up a lot.

I have also had weakness in my facial and neck muscless since january. I was reassured last summer with the results but with the progression of symptoms in my leg, neck and face as well the arms (muscle wasting, weakness and dropping things) . I am no longer sure. I plan to push my GP for a muscle biopsy now as had all the mri, bloods etc with nad. This has been going on now for 18 months without any answers. First I was misdiagnosed with carpal tunnel last year.

I would also like to say I was sad to hear trfogey died. He whas been quite blunt with me the few times I have posted over the year but I read a lot of his posts and it seems he put a lot of thought and energy into replies on this forum.

My thoughts are with his family and friends.