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Double A

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Hello to all, I just have a question about my most recent emg and ncv. It was stated that both were abnormal. It showed chronic denervation with partial reeinnervation along with many fasiculations without psws and fibs present. The ncs showed peroneal nerve motor damage slowed about 25% on right leg only. Also they're were many polyphasic potentials on the right side compared to left. I'm just very frightened by all this as all my blood tests and MRIs are normal, and they're just running out of things to rule out. Plus it feels like I walk different on right leg but wife looks at my gait and says it appears normal so idk anymore. Any advice on this wld be helpful, thank you to all.
 

affected

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I would sit down and ask my neurologist to explain it all - that person has clinically examined you and can put it all into perspective for you. All the best.
 

Double A

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The nueromusclar Dr said that for als it's needs to be acute/active denervation along with reeinnvation but it's so confusing with this whole chronic and active type thing. Does active always come before chronic or can active/acute show up after chronic denervation? Thank u for you're time.
 

Nikki J

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ALS causes ongoing active denervation that spreads through the body. The denervation will become chronic but there is an active process in the next affected area. Reinnervation is the body’s attempt to compensate.

When you see chronic only with reinnervation it sounds like there was damage ( as from an injury ) and the body is repairing/ compensating. Ncs is normal in ALS usually. It sounds like you were told not ALS? Do you not believe the neuromuscular specialist?
 

Double A

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Hello Nikki, thanks so much for that kinda information. The Dr didn't mention too much, he was trying to point it to my back but all lumbar MRIs and lower extremity MRIs are coming back normal so it does get scary when it seems like options are running out. I'm not familiar with the whole denervation/reeinnvation thing. But it sounds like you are saying that if it was als happening in my body then active deneveration wldve shown up along with chronic denervation is that correct? Since I have chronic already and not active, is it possible that active could show at a later time? I'm sorry for these questions as I won't take much of y'all's time, just kinda wanted a lil clarification that's all. Thanks.
 

Double A

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It also said I had reduced recruitment and increased amplitude and duration on one of my right leg muscles. But is motor nerve affected in ncs the same as motor nueron damage in als?
 

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As Nikki said, the NCS is usually normal in ALS. What is the specialty of the doctor that performed the EMG? It sounds like they are saying no ALS which is great news. I hope you get answers soon.
 

Double A

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Hi Kristina, thank u for kind words. He is a nueromusclar specialist and I do trust him, but he never really went over the whole deneveration/reeinnvation thing so I just wondering if that was something you wonderful people might know. I'm just really worried that active deneveration may show up later on when I have next emg since I already have chronic. Clinically I have an absent ankle reflex on right and left is diminished. And a mild weak big toe on right foot.
 

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I wouldn’t get too caught up in the wording of the EMG report. I had one study showing chronic denervation (without acute changes) and a subsequent study showing both acute and chronic changes.

EMG interpretation is highly operator-dependent. What’s most important in diagnosing ALS is the big picture: Evidence of muscle function failure (at least one muscle group not working right), both upper and lower motor neuron changes, characteristic EMG changes in multiple spinal segments with normal nerve conduction tests, ruling out other conditions which mimic ALS, and seeing evidence for disease progression over time. If you don’t meet all these criteria, a qualified neuromuscular disease specialist won’t diagnose you with ALS.

And an absent ankle reflex would not be characteristic of ALS. Expect hyper reflexes with ALS.
 
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Double A

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Thanks Karen I just wanna cry dealing with this. And I'm a man who works in oilfield industry who supposed to be tough. Lol. Yeah the whole absent ankle reflex thing just brings lower motor nueron to my mind, and limb onset is constantly on my mind as I am starting to feel a burning/tearing feeling on my left leg muscle which started 3 weeks ago. Is that how limb onset moves? Pals and cals I will be making a donation here soon btw for all y'all do here. Thank you for listening to me.
 

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Hello-

It sounds like you are in serious need of a conversation with your doctor. If he didn't go over the results with you and you still have questions, you really need to discuss with him. Your last post indicates the lack of information is causing you some serious worry and you are turning to the internet instead of getting the info directly from the horse's mouth. Your doc has all the information- not just the emg results, but the results of clinical exam and full medical history. I highly recommend you speak to the doctor again and outline your concerns and identify the issues you have the most concern over so they can explain what it means to you.

I may have missed it in your posts, but what have you been told as far as the next step? Where do you go from here? Specialist referral? Another appointment in 6 months? Or did they say you were good to go and there was no further need to see them?
 

Double A

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Hi shift kicker, my nuero is a nueromusclar Dr who has specialities in als and other nueromusclar diseases. He told me I didn't have als from my clinical exam and emg bc he didn't see any acute/active denervation even though chronic denervation along with reeinnvation, he said I needed acute. My fasiculations he said appeared in single morphology which can be benign fasiculations. He really doesn't know what's causing my symptoms or damage to right leg muscles. He did say that the deneveration seems to be very old whatever that means. But we've done MRIs and everything so far is normal. I have another emg in April which wld be 6 months.
 

Kristina1

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It sounds like you are in good hands with an experienced neuromuscular specialist. Like Karen said, ALS involves a constellation of clinical and electrodiagnostic results. It is not diagnosed on just one thing. It sounds like your clinical exam did not show signs of motor neuron degeneration consistent with ALS. Your EMG was also, per your neurologist, not consistent with ALS. I know it's hard to hear "no ALS, but we don't know what's wrong." Not having an alternate diagnosis to take home probably makes you worry "what if..." about ALS. I can imagine that is scary. I agree that you should have another discussion with your doctor about your concerns. Tell him/her about your fears. I bet they can outline exactly how they made their determination and set you more at ease. Good luck.
 

Double A

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Karen, wow that mustve been frightening to have one emg just show chronic denervation and a later one show acute and chronic denervation. I'm sorry to hear that happened to you. U said once it moves to another part of body it'll show active process, but what about if it's already affecting one leg, hence limb onset would it not show acute/active if als was the cause?
 

lgelb

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Just the slight correction that ALS does not always present with "hyper" reflexes -- they can be weak or absent if onset is lower motor dominant or the person has a pre-existing myopathy, for example.

The key here, Houston, is that no PSWs or fibs were seen in your EMG, which argues strongly against ALS. From what you say, it also appears that nerve damage was only seen in a limited way (R leg), which is another argument against. In ALS, multiple regions would show abnormalities because the EMG sees damage before the person experiences it. The hallmark of ALS is specific abnormalities in muscles that have not as yet failed to work.
 
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