Could this be ALS? I appreciate the input greatly ....

[Andjelam]

Hey everyone! I’ve been following this forum for a while since started twitching and having weird numbness 10 months ago.

I am a 25 year old female registered nurse. I have had clean MRIs ruling out MS. I had an abnormal somatosensory evoked potential in my right tibia that my neuro did not know what to make of. I finally had an NCV and EMG last week where the neuro pointed out that my right foot Extensor Digitorum Brevis muscle is completely atrophied and produces no signal at all. I of course started to freak out but she said that if it were ALS the rest of the muscles would show dennervation on EMG. She said my NCV showed some more slowing at the knee, but the EMG was done super quickly and she seemed to think nothing of it. She is scheduling me for a follow up EMG in three months.

I am now paralyzed with anxiety because I cannot think of one thing that would cause a foot muscle to atrophy in isolation (apparently my lumbar spine is clear). I have no noticeable weakness and the atrophy has been present for at least 6 months according to photos. This muscle is an accessory muscle so it’s atrophy would not affect function.

Has anyone had a similar situation/can offer any advice on next steps? Thank you!!

 

[Bestfriends14]

In ALS atrophy comes after the muscle fails. If you see atrophy and you do not have muscle function failure, it's not because of ALS. Atrophy happens when a muscle is in disuse, for example, in foot drop the foot is no longer able to go up on toes or back on heel. Because of this issue of these muscles, the calf muscle starts to atrophy, and from there, the rest of the leg as more and more muscles start to die.

You appear to have no signs of ALS as per doc's opinion, lack of ALS symptoms, clinical exam, and EMG and NCS. That's fantastic news and a reason you can let this worry go. As to what is going on, it's best to continue working with your doctor.

Good luck to you and take good care.

 

[lgelb]

An abnormal SSEP + an atrophied muscle nearby certainly suggests local damage -- it could even be a hereditary condition or unrecognized trauma. The good news is twofold: it doesn't seem to affect your function much, and it's not ALS.

I'm not clear on why you're undergoing testing to begin with, but perhaps an orthopedist and imaging of the R lower leg could make more sense of your situation.

Best,
Laurie