montanancee
New member
- Joined
- May 21, 2020
- Messages
- 2
- Reason
- Learn about ALS
- Diagnosis
- 00/0000
- Country
- US
- State
- NY
- City
- NYC
I am wondering if the great folks on this board can help clarify how to read some Internet horror stories out there--such as where clean EMG did NOT = no ALS. Before asking my question though, I just want to thank the PALS and CALS who respond to nervous folks on this forum. You are truly saints.
My Q:
I understand that, as a rule, clean EMG almost always = no ALS. The conventional wisdom here seems to be that the exception to this rule is for UMN symptoms. If they are the only presenting symptoms, the EMG (will/may) come back clean. But, if LMN symptoms--such as twitching--are presenting, the EMG will not come back clean.
The problem, though, is that there are enough contrary stories on the Internet right now that simply suggest this rule isn't true--or, at least, that it is an oversimplification. Take this example: . By his own description, this PALS's progression was: twitching -> clean EMG -> weakness -> dirty EMG/ALS diagnosis. If you look enough, you can find other stories out there (although usually not with video).
So what's the explanation? Was the first EMG administered by someone incompetent? (does this really happen?). Is the individual I linked to a liar? (seems unlikely, his videos show he is clearly a PALS, and so why lie about this?).
I'd be so deeply indebted to somehow who can explain away this riddle.
One additional Q, though, that may ultimately be nearly a good as the "clean EMG = no ALS" rule. Are PALS able to make their ALS fascics STOP? Example: If you start walking, will your leg fasciculations stop? Does stimulation (a shower, for example) make them stop? I think for many BFS folks these activities will stop them. But I have never seen a PALS describe whether they can control their fasciculations.
My Q:
I understand that, as a rule, clean EMG almost always = no ALS. The conventional wisdom here seems to be that the exception to this rule is for UMN symptoms. If they are the only presenting symptoms, the EMG (will/may) come back clean. But, if LMN symptoms--such as twitching--are presenting, the EMG will not come back clean.
The problem, though, is that there are enough contrary stories on the Internet right now that simply suggest this rule isn't true--or, at least, that it is an oversimplification. Take this example: . By his own description, this PALS's progression was: twitching -> clean EMG -> weakness -> dirty EMG/ALS diagnosis. If you look enough, you can find other stories out there (although usually not with video).
So what's the explanation? Was the first EMG administered by someone incompetent? (does this really happen?). Is the individual I linked to a liar? (seems unlikely, his videos show he is clearly a PALS, and so why lie about this?).
I'd be so deeply indebted to somehow who can explain away this riddle.
One additional Q, though, that may ultimately be nearly a good as the "clean EMG = no ALS" rule. Are PALS able to make their ALS fascics STOP? Example: If you start walking, will your leg fasciculations stop? Does stimulation (a shower, for example) make them stop? I think for many BFS folks these activities will stop them. But I have never seen a PALS describe whether they can control their fasciculations.