Conflict? EMG suspects myopathy, Muscle Biopsy shows denervation w/reinervation

[Kollati]

EMG

Appears to be abnormalities in multiple regions with FIB, PSW, increased ease of recruitment and small amp MUP's. Suspected myopathy, but from my research this seems more like MND findings.

Note: EMG was done after Muscle Biopsy sample was taken, but before biopsy report was released.

Muscle Biopsy

Denervation atrophy with reinnervation. Specifically ruled out myopathy. My research indicates this could point to an MND in the absence of differential diagnosis.

Clinical Correlation

Will the deciding factor in the eventual diagnosis be the clinical correlation in this situation?

I am seeing a Neuromuscular specialist in two weeks, but would appreciate the insights from this community.

Thank you for your time.

 

[Nikki J]

Let us know what the doctor says No your emg does not look more like mnd than myopathy
someone blocked out so much of the text of the muscle biopsy report that it is completely impossible to comment On that

 

[Kollati]

Excerpt from NIH article: Electrodiagnosis in ALS

To support a diagnosis of ALS, the needle electrode examination should reveal decreased motor unit recruitment with rapid firing of a reduced number of motor units, and/or large amplitude, long duration MUP with or without evidence of remodeling (increased number of phases) in combination with abnormal spontaneous activity including positive sharp waves (PSWs), fibrillations, and/or fasciculation potentials (FP).

It seems the EMG had all of these factors. Can you clarify why it doesn't look like MND?

Try this attachment for the muscle biopsy. See pg 2 and 3.

 

[Nikki J]

because you have increased recruitment and smaller amplitude mups according to your report and ALS is the opposite. Spontaneous activity alone is not diagnostic of ALS and can be seen in other diseases including inflammatory myopathies. How this correlates with your muscle biopsy will be up to your doctor to decide but I will be surprised if they jump to ALS given the emg and your history which I read in the reports as I suspect there are other explanations for the biopsy result just as there are when an emg show denervation with reinnervation ( which yours does not) but it is of course for your doctor to determine Please let us know what they say