EMG and possible ALS symptoms

[craiginchicago]

Hello,
I am 50 years old and for over a year I had left leg weakness and have had a difficult time walking at times. I finally had an EMG done on my left leg about 2 months ago.

The needle EMG examination was performed in 5 muscles. It was normal in 4 muscle(s): L. Tibialis anterior, L. Peroneus longus, L. Tensor fasciae latae, L. Lumbar paraspinals (low). The study was abnormal in 1 muscle(s), with the following distribution: The L. Gastrocnemius (Medial head) had abnormal spontaneous activity.

Now, a month later, I am starting to have weakness and twitching in my left arm and hand. The MD that did my EMG said he didn't "think" I should be worried about ALS.
The NCS/EMG findings of the left lower extremity revealed a findings suggestive of a chronic left tibial neuropathy affecting the Gastrocs (less likely S1 radiculopathy given no other muscle involvement). 　
Should I completely stop worrying about ALS with this EMG?

Thanks for any thoughts.​

Sensory NCS

Nerve / Sites​	Rec. Site​	Onset Lat​	Peak Lat​	NP Amp​	PP Amp​	Segments​	Distance​	Velocity​
​	​	ms​	ms​	µV​	µV​	​	cm​	m/s​
L Sural - Ankle (Calf)​
Calf​	Ankle​	3.28​	3.80​	8.5​	1.4​	Calf - Ankle​	14​	43​
Ref.​	​	​	≤4.20​	≥5.0​	≥5.0​	Ref.​	​	​

​

Motor NCS​

​

Nerve / Sites​

Muscle​

Latency​

Ref.​

Amplitude​

Ref.​

Amp %​

Duration​

Segments​

Distance​

Lat Diff​

Velocity​

Ref.​

​

​

ms​

ms​

mV​

mV​

%​

ms​

​

cm​

ms​

m/s​

m/s​

L Peroneal - AH​

Ankle​

AH​

5.31​

≤6.00​

4.5​

≥3.0​

100​

6.25​

Ankle - AH​

8​

​

​

​

Pop fossa​

AH​

11.98​

​

5.0​

​

110​

7.29​

Pop fossa - Ankle​

31​

6.67​

47​

≥39​

Ankle​

ADQP​

13.91​

​

4.9​

​

108​

7.45​

Ankle - Pop fossa​

8​

1.93​

42​

​

L Tibial - AH​

Ankle​

AH​

4.17​

≤6.00​

13.2​

≥3.0​

100​

6.93​

Ankle - AH​

10​

​

​

​

Pop fossa​

AH​

13.49​

​

10.0​

​

75.6​

8.28​

Pop fossa - Ankle​

41​

9.32​

44​

≥39​

​

EMG Summary Table​	​
​	Spontaneous​	MUAP​	Recruitment​
Muscle​	Nerve​	Roots​	IA​	Fib​	PSW​	Fasc​	H.F.​	Amp​	Dur.​	PPP​	Pattern​
L. Tibialis anterior​	Deep peroneal (Fibular)​	L4-L5​	N​	None​	None​	None​	None​	N​	N​	N​	N​
L. Gastrocnemius (Medial head)​	Tibial​	S1-S2​	N​	None​	1+​	None​	CRDs​	N​	N​	N​	N​
L. Peroneus longus​	Perineal​	L5-S1​	N​	None​	None​	None​	None​	N​	N​	N​	N​
L. Tensor fasciae latae​	Superior gluteal​	L4-S1​	N​	None​	None​	None​	None​	N​	N​	N​	N​
L. Lumbar paraspinals (low)​	​	-​	N​	None​	None​	None​	None​	N​	N​	N​	N​

​

　　

　　

　　

 

[Nikki J]

If it were ALS the emg should have showed more - both in that muscle and the surrounding ones as well as tge paraspinals.

have you been examined since the hand symptom? Whenever you were last examined were there findings of clinical weakness, abnormal reflexes or spasticity at least in the affected area?

depending on the credentials of the original doctor you may want a second opinion but just going by the emg that did not show ALS

 

[craiginchicago]

He said I had weakness in my left leg. He didn’t say clinical weakness but I guess I don’t know the difference between the two.
after reading some of these posts, I’m also having a lot of tingling and numbness, and occasional pain which I think makes ALS less likely?
I appreciate you answering my post.

 

[KimT]

Tingling and numbness do point away from ALS. Work with your neurologist.
Usually widespread activity is evident on EMGs even before weakness and yours doesn't show it at this time.

 

[craiginchicago]

Are you saying that the EMG done in my left leg would have shown widespread ALS activity and even caught weakness in my left arm and hand?
Thanks for answering.

 

[lgelb]

Yes. Not "caught" weakness as such but the hallmark of ALS is certain abnormalities in all or most muscles tested. ALS is not the picture on this EMG.

 

[craiginchicago]

Thanks for all your help! The doctor that did my EMG said he would do an EMG on my hand/arm but after hearing what you all have said, it sounds like it would be a waste of money and time.

Thanks again!