EMG results, help with interpretation

[Rgb123]

Hello to all the amazing members here. I am hoping to get some insight about my recent EMG/NCS. Quick backstory for context.

About 6 months ago I was out sledding with my kids. The next day my legs were twitching somewhat. Not realizing at that time that I had inadvertently worked out (going up and down the hill many times), I googled reasons for twitching (big mistake, I know). The fear of ALS crept in, the twitching increased over the next week or so (all over my body), as did the hypnic jerks, anxiety, etc. I have a history of health anxiety. After reading some helpful stickied threads here, I realized that my twitching did not fit the description of ALS. I calmed down a bit and the twitching substantially decreased.

However the fear of bulbar onset took hold and off and on for the past 6 months I have been dealing with intermittent, perceived speech issues (not noticed by anyone else). Twitching was essentially gone (I can't really remember, I wasn't focusing on it). Had an all clear neuro exam 3 months ago. Was doing better mentally but went down the rabbit hole again with some recent stress. Decided to ask for an EMG which was earlier this week. Mainly wanting to rule out bulbar issues.

Leading up to the EMG I thought to myself, I hope I don't go in there twitching and throw off the test. So naturally, the twitching started again. Mainly in both of my calves but elsewhere too, just not as much. The EMG neurologist (different one) tested my strength and reflexes, all normal. Checked my tongue for strength and fasciculations, also normal. Right trapezius muscle tested, normal. Also checked both legs, some paraspinals, and NCS (which the NCS had some abnormalities). She verbally went over my findings with me which are consistent with the summary in the report. So my fear of bulbar was abated, and no surprise my perceived speech issues went away almost instantly.

She did find some activity in the left calf. With my focus on that now, the twitching in the calves has persisted (both right and left). I have no weakness that I can tell. Some history of lower back pain/sciatica (nothing extreme, but one bought several years ago that was good enough where I got checked out for a hernia due to pain). I am a dentist and we typically have neck and/or lower back issues.

Anyways, due to some of the findings, I am a bit worried. However her report suggest peripheral neuropathy, possible radiculopathy. She said the results are not consistent with MND. She has many years experience and I am inclined to trust the doctors. However given my anxiety and how knowledgable some of the members here are, I am wondering if any of this (my story, neuro exam, 6 month timeline, EMG results) looks concerning from the perspective of MND.

I have not followed up yet with my neurologist since the report just came through a few days ago. Thank you for taking the time to read this!

 

[lgelb]

Everything looks as she said. I would consider a gel mat when working on patients and re-evaluate your posture/shift your weight during procedures to avoid stressing out your back/calves when you can. You could also get a PT eval and suggested exercises to calm your calves. Essentially, seems like you have a kind of long-term overuse injury, possibly exacerbated by the sledding session, that could use some targeted therapy.

The twitching didn't throw off the EMG, and nothing you have said sounds like ALS.

 

[Rgb123]

Thank you for your reply and thoughts. I truly appreciate it and take to heart what you said. It gave me relief, so thank you

Regarding the PSW's and fibs, I take it they are not concerning in terms of ALS given the singular location? I mean, obviously given what you and the neurologist said. That was the part of the study that gave me pause. Google is resoundingly unhelpful and misleading when researching these things (I've stopped) and as I often say about many things, I know just enough to be dangerous...

Additional data point, I just heard from my main neurologist. She echoed the same thoughts as the conclusion of this study and said it is not suggestive of MND at this time.

 

[lgelb]

Yes, that is correct. You may have mild primary nerve damage or a mild spine issue at S1 that is affecting your calves. That is why I would suggest looking at both how your spine is bent forward/curves to the side when you work, and also the strain you are putting on the calves themselves. As you know, good shoes are also important for that stability and ability to shift position without losing focus. But if you adopt a mat, you would probably find that softer, less structured shoes would mesh better with the mat.

 

[Rgb123]

Will look into all that for sure, thank you for the suggestions! Who knows, maybe this whole journey will catch some musculoskeletal things early before the damage is more extensive. Many dentists are physically pretty wrecked after years of practicing. I will work with my neurologist to see what we can find out.

Thank you again, your time and expertise are so appreciated.