Concerned about my husband - attached history and EMG

[Marieb425]

Hello,

I was wondering if anyone might be able to look at my husband’s EMG report (abnormal) and see if it looks similar to how theirs did before a diagnosis? He has weakness in his left hand and some muscle atrophy. He went to an orthopedic doctor who ordered an EMG (attached) and then after that two MRI’s for the neck/spine and shoulder. The MRI’s were normal and the EMG was abnormal. Three doctors who reviewed the EMG’s and MRI’s said he needs to see a neurologist (in the past 24 hours). We’re just trying to prepare ourselves for if this might be an upcoming ALS diagnosis and would greatly appreciate any insight. Thank you so much.

 

[Nikki J]

There is no recruitment or mup abnormality and both are seen in diagnostic ALS emgs. I had these as did my sister since you ask how they compare to our experiences.
Did the doctor mention ALS?

 

[Marieb425]

Thank you Nikki, I really appreciate the reply and information. Yes, one of the doctors said it couldn’t be ruled out at this point.

 

[lgelb]

The localized nature of the abnormalities is reassuring. As the summary notes, the findings are confined to C8/T1 acute denervation, yet evidently imaging did not find an injury or mass. This would explain why the one doc said ALS could not be ruled out, but this is hardly an EMG to "rule it in." The neurologist may order some additional tests.

And as Nikki says, there is nothing on the right side of the table, which is also reassuring as regards ALS.

Best,
Laurie

 

[Marieb425]

Thank you both for your replies. The update (since I posted this in june) is that he began having slurred speech and he has weakness of his tongue with fasciculations. He had the neurologist appointment last week and the neurologist said his symptoms are concerning for a Motor Neuron Disease and he is concerned about ALS. He has a brain MRI and a repeat EMG scheduled for this week and we will see what the results show for those.

Additional details from the neurologist visit:
-Mild hyperreflexia of the left upper extremity. (Reflexes are 3+ in the left upper extremity).
-1-2 beats of clonus on the left with no clonus on the right.

 

[KimT]

The only comment I would make is that he should be seen by a neurologist who specializes in neuromuscular diseases.

 

[Marieb425]

Thank you Kim! We will make sure to ask that at the appointment this week. I’m wondering if after the EMG the current neurologist might refer him to somewhere else (depending on results). He’s has 2 clear MRI’s and so they haven’t been able to find a cause, so far.

 

[lgelb]

Does the current neurologist have a specialization or are they a general neurologist? Was this at the Polyclinic also (noticed the hand surgery assessment and EMG were there)?

If so, I would give serious thought to bailing on the second EMG and going straight to a neuromuscular center, which the Polyclinic is not, because if you are in the Polyclinic neck of the woods, you are likely going to end up at Swedish, Virginia Mason, or UW, and they are going to want to do their own EMG.

 

[Marieb425]

That is really helpful - we didn’t know Polyclinic is not a neuromuscular clinic. They referred him to this neurologist and he didn’t seem to have a choice. He tried calling the UW clinic back in July (when we noticed the slurring speech) and they said they wouldn’t see him without a neurologist referral. I guess he has to go back to the Wednesday appointment and do the EMG and then maybe he can get a referral to one of the other clinics? Thanks!

 

[lgelb]

No, the neurologist that saw him can certainly make the referral without a second EMG. Once you tell them that ALS is suspected, using the neuro as your referral source, UW hopefully can offer something fairly soon (diagnosis is prioritized, obviously), but if not, you can call the other two [maybe not Swedish -- they seem in transition right now, but there's CHI in Tacoma, as well, and Kaiser has an appropriate specialist if they are in your network -- rotates between Capitol Hill and Federal Way, I think] and take the soonest available.

Later, if needed, you can switch to your preferred clinic for followup.

 

[Marieb425]

Thank you. He messaged the neurologist this morning and they are sending a referral to the ALS clinic at UW today.

 

[Marieb425]

I just wanted to update the thread that unfortunately he now has a “probable ALS” diagnosis from the neurologist. I’m a bit too tired and overwhelmed to update with more details then that but he also has referrals to neuromuscular specialists.

 

[affected]

Sorry to hear this Marie, but it was not given by a neuromuscular specialist?
That is where you really need to be. I hope you can get an appointment soon.

 

[Marieb425]

Thank you. Yes it was given by the general neurologist and he did say he needs to go to a neuromuscular specialist. The most recent EMG had recruitment (I know the original one was missing that) and showed progression from the last one in June. He has referrals to a couple specialists in Seattle and we’re considering traveling to Portland too. He has one appointment scheduled in two weeks but we’re not sure if we’ll keep it because he wanted to be seen by the experienced doctor and they scheduled him with a younger one.

 

[KimT]

If the younger one is a neuromuscular specialist, don't cancel because of age. They are very well trained. Most people get a second opinion. I got three and another later.