Could this be MND?

[granite09]

Hi
I have been having neurological symptoms for 9 months now. Twitching, cramps mostly in my legs, shortness of breath on extertion, and muscle pain (of which I am aware isn't normally an early als feature). My exams from Neuromuscular doctors have just shown brisk reflexes with no other significant findings. My recent EMG after 9 months read Normal for insertional activity, fibs, psw, fasc, and MUAP. However in several parts it said Reduced for the firing #. Im curious if the reduced firing rate (assuming this means recruitment) can be an early sign of MND? I have no weakness yet after 9 months but symptoms are worsening. PFT has been unremarkable as well. Could this be something like slower onset PMA or would the EMG show certain features after this amount of time. I have read PMA takes longer to diagnose and unsure if that is due to the EMG becoming dirty or the neurologist being unable to identify what varient it is early on. Thanks.

 

[lgelb]

PMA is essentially a term for lower motor neuron-dominant ALS these days, and often not used at all any more. The UMN component of ALS is generally not seen on a standard EMG, so most PALS' UMN problems at diagnosis, if there are any, are seen on exam.

Abnormalities in recruitment only do not signal ALS because that would not meet the criteria of both acute and chronic denervation, and this has nothing to do with PMA because it is just a variant of the same thing. But without seeing your EMG, you should be discussing possible differentials with your neurologist, as well as where to go from here.

Since you have shortness of breath and normal PFTs, a sleep study might be revealing, at least for ruling some things out. That could be another question for your neuro. I would also consult with your PCP to make sure systemic possibilities have been explored with lab work and see him/her periodically so any key changes can be noted.

Best,
Laurie