Status
Not open for further replies.

Tb12

Member
Joined
Mar 15, 2013
Messages
27
Reason
Learn about ALS
Diagnosis
00/0000
Country
US
State
NY
Hi guys, i am a 28 year old male. I have been having all over body twitches, weakness, muscle fatigue for over a month now, I have seen 2 neurologist's both said they were not concerned and they were happy with the physical exams they gave me, however one neuro requested a emg and my go recently got the results but my neuro has gone on holidays for over a month, I am really concerned. My emg report states the following:

Coaxial needle sampling: the following muscles were sampled using concentric electrodes on the left side,tibialis, anterior, medial gastroc, vastus medialis, first DI, exterior muscles of the forearm and biceps. There was no abnormal insertion activity, there was no spontaneous activity, the interference pattern was not completely normal. This was a patchy process, both distally and proximally and there was some large amplitude units seen.

Comment: this is mildly abnormal study, distal motor latency, amplitude and cap, motor conduction and sensory conduction are normal where tested. Muscle sampling was not completely normal. There were no signs of irritability, spontaneous activity but the ability to recruit motor units was reduced in a patchy fashion and there were definite large amplitude units seen suggestive of some mild chronic denervation.

Can someone please shed some light on this result? Ant info would be greatly appreciated. I can't get into a neuro anytime soon, really worried.

I would like to note I have buldging discs in my lumbar spine as well as spinal stenosis and degenerative disc disease.. Not sure if that can be connected. Look forward to hearing from you.

Trent
 

CathyP

Active member
Joined
Feb 29, 2012
Messages
91
Reason
PALS
Diagnosis
12/2011
Country
US
State
Kentucky
City
Small Town in Western KY
Wright is our medical expert on this forum. Send him a message with your info and see what he says.
 

notme

Extremely helpful member
Joined
Apr 3, 2011
Messages
2,581
Reason
PALS
Diagnosis
08/2011
Country
US
State
Fl
City
Orlando
I think you asked this in the other section as well. Please try to keep hte same question in the same section - less confusing.
 

wright

Very helpful member
Joined
Jan 12, 2008
Messages
1,160
Country
US
State
xx
City
xxxx
I really cannot give you a firm opinion without knowing what muscles were tested. What I can tell you, though, is that what you have shared does not point towards ALS (that goes for your history and EMG results). Chronic denervation alone is not indicative of ALS. There would definitely have to be active denervation picked-up by the EMG and you have none of that. To me it appears to stem from your spinal issues.
 

Tb12

Member
Joined
Mar 15, 2013
Messages
27
Reason
Learn about ALS
Diagnosis
00/0000
Country
US
State
NY
Hi wright, thanks for the opinion it's greatly appreciated and made me feel much better, I believe it tells you what muscles were tested on the top half of my emg post. It was my left leg, left arm and left hand, if that helps. Thanks again.
 

ckjvoris

New member
Joined
Apr 16, 2013
Messages
4
Reason
Learn about ALS
Country
Uni
State
Indiana
City
knightstown
I'n new to this forum so please excuse my lack of knowledge of how to navigate through things. I read that "Wright" is knowledgeable with the emg/nvc test. I have not seen all the results from my emg/nvc however, the neuro that did the test told me that there was a 30% loss of nerve velocity that included the leg, arm, throat and tongue and he felt they were on the right track with als and mnd diagnosis. The neuro that I see during my office calls makes references to pls/als but tells me we "watch" at his point. I have many other symptoms and not sure of where or who to ask about them....muscle twitching and atrophy, difficulty swallowing (mostly liquids), balance problems, fatigue, problems with sleep,(I am now on a bipap) breathing problems,(shortness of breath that is worsened when I lye down) I can't sleep lying flat I have to sit up. Like I say lots of problems just not sure where to start. Any help here would be greatly appreciated.
 

vickim

Very helpful member
Joined
Sep 20, 2012
Messages
2,255
Reason
Friend was DX
Diagnosis
03/2012
Country
US
State
MO
City
aaaa
If you want Wright to look at you results you will need to post a copy of the test that has all the numbers. You have come to the right place. There are many very smart people here. Others will chime in with support and advice. You can read through the threads. Lots of information and help.
 

Annie's Phil

Distinguished member
Joined
Nov 22, 2011
Messages
302
Reason
Lost a loved one
Diagnosis
07/2007
Country
US
State
MD
City
Eastern Shore of Maryland
I'm no expert in this, but I'm puzzled why a 30% reduction in nerve conduction velocity would be considered consistent with a diagnosis of als. All that I've ever read states that reduction in nerve conduction velocities are the result of peripheral nerve damage, such as the demyelination that occurs in diseases like multiple sclerosis, or due to local trauma. In als the motor neurons (in the central nervous system) die and no longer provide nerve impulses to be conducted through the nerves to the affected muscles.

It's kind of like an electrical circuit with a switch, wires, and motor, where the motor is the muscle, wires are the nerves, the motor neurons are the switch. All three must be working properly for the motor to operate normally. In als the switch is damaged, but the wires are fairly normal. Velocity studies that show normal or only slightly (~10%) low nerve conduction velocities indicate that the nerves (wires) are functioning and indicates the problem is with the switch (motor neuron) and is typically what is seen in als.

If the conduction velocities are much lower then that indicates a problem with the wires (peripheral nerves) and is not typical of als. In this case, the switch (motor neuron) is working fine, but the wires are damaged and much of the impulse is short circuited. Thus the signal is slowed to the muscle and it's amplitude is reduced.

Clearly more data is needed (e.g., emg results) but I'm surprised that based on your NCV results it's being suggested that it looks like als. Was it actually a neurologist that told you that (after the NCV results), or was it a technician that performed the test?

The EMG provides completely different but complementary diagnostic data to the NCV. When the NCV shows the wires (nerves) are normal and the EMG indicates fewer motor units are being recruited during voluntary contraction, that's indicative of damage to motor neurons. The EMG will also give evidence that after muscle motor units are no longer being supplied by a motor neuron that new nerve branching will form to try to tie in to the signal still being provided to nearby motor units (referred to as denervation-reinnervation). This is characteristic of als.

Clearly you have something serious going on. But based upon a 30% reduction in NCV, I would be looking for something other than als. Since it's wide spread, that would seem to rule out local trauma (like herniated disk or pinched nerve) and suggests something systemic. I would certainly ask your neuro at your next visit how the 30% reduction in NCV is consistent with als. I wouldn't be surprised if your your neurologist draws a completely different conclusion than the person who did the test.

As I said at the beginning, I'm no expert in any of this and am only relaying information from what I have read and experienced during the course of my wife's disease and diagnosis.

I wish you well and an accurate diagnosis, and that it proves to be something other than als and is treatable.
 

ckjvoris

New member
Joined
Apr 16, 2013
Messages
4
Reason
Learn about ALS
Country
Uni
State
Indiana
City
knightstown
OK, seems you have alot of knowledge regarding the nerve issue....let me explain a little more. I'm the one that said 30% nerve loss not the neuro that did the emg/nvc. I said that because of the way he explained things to me. What he described to me was that the nerves are like an interstate highway and that everyone else was going 65-70 mph and I was going about 50 or 55 mph. and that it involved the muscles of the legs, arms and tongue. Rather than use an analogy I just did some math and came up with the 30% figure to use here rather than explain what he said which is apparently not the way to do things. He also said the he could visually see, and feel the twitching and that he could see them on the scope. He referred to them as fasciculations. He also said the what he was seeing with the emg/nvc was typical of what he has seen in MND and felt that they were on the right track with things. He used the term Lou Gehrigs disease. Here is a list of medical test that have been run in the last 12 months. eeg, full body catscan, about 40 different blood test, mri's of the head,cervical and lumbar spine, 24 hour urine analysis, upper gi was done when I started have problems with swallowing, 2 sleep studies that showed obstructive sleep apnea. I was put on a cpap and was having terrible results with it as I started feeling that I could not exhale against it's pressure. After the emg/nvc he switched me to a bipap that I get along with better but have found a need to sleep sitting up more than lying flat. The neuro used the term negative for all the results to the test. After the emg/nvc he ordered a few more blood test but used the term "normal" on these. The only test that has showed a problem was the emg/nvc. At my last visit he said primary lateral sclerosis is what we need to keep our eyes on and that he could not "pinpoint" things at this time. These neurologist have used words and terms that I have never heard of before and they can be rather intimidating. Really don't know what questions to ask either. They have not run anymore test since the few blood test after the emg/nvc.
 
Status
Not open for further replies.
Top