EMG results. What is a possibility of MND?

[Dmitry12345]

Hello to everyone and thank you in advance to all who have taken the time to read and response.
I am 28 years old male living in Russia - 200 cm tall.
My problem started 4 month ago in august. It was kind of "twitching attack", when I wanted to fell asleep, I've noticed that all my body started twiching very strongly (legs, whole body, arms), my fingers were moving by theirselves. This has never happened to me before.
So I decided to go to a neuromuscular specialist after one week from the beginning of the symptoms. He made an examination, everything was fine except slightly brisk reflexes and positive Hoffmans sign on both hands, but he didn't think much of it.. All the strength test were normal, no weakness.
He also made an emg of two muscles, everything was normal, even no fasciculations and he said that it is BFS.
3 months later I decided to go to another ALS specialist to confirm the BFS dx. He also made an examination and strength tests, everything was normal.
Then he did an emg which showed abnormalities:
Left thenar - 4 fasciculations, polyphasic potentials - 30%, amplitudes and duration was normal
Left deltoid - 2 fasciculations, polyphasic potentials - 40%, amplitudes and duration was normal
Left calve - 18 fasciculations, 1 fibrillation and 1 psw, polyphasic potentials - 60%, amplitudes and duration was normal
He told that active denervation might be because of my lower back issues. I've made an MRI of lower back that showed few herniated discs. Also I've made a big blood panel which came back all negative. So he things that all I can do is wait and repeat emg in a few months..

So what do I have at this moment.
4 months passed, I have 24/7 twitching of my calves and feet. Also 2 moths ago I've noticed that my right thenar is twitching constantly and I can provoke it by slight contraction of the muscle.
I have strong tremor in my legs and feet when I'm trying to hold a certain position.
No weakness and atrophy.

My questions are:
Could this be MND?
Can be the denervation of my calves caused by the back issues?
What do you thing about emg, how bad is it?

Any thoughts would be much appreciated. Thank you for your time!

 

[lgelb]

From what you say, there was active but not chronic denervation, which would rule out ALS and support the idea that your spine issues may be affecting your legs. I would seek a referral for physiotherapy, and I would also ask about the possibility of restless leg syndrome. But you have not described any reason to worry about MND.

 

[Dmitry12345]

Thank you for your reply!
The bad thing is that although my neurologist told me that active denervation may be caused by my lower back issue, he can't rule out ALS at the moment especially because there are "too many fasciculations in your calves with denervation"..
Could you please advise if Hoffman's sign on both hands is something that I have to worry?
Also twitching of my right thenar for more then 2 months making me so anxious.. But it seems that I still have no weakness of that muscle.
Yesterday I went to the gym and noticed that it was very hard to make exercises on my legs even with the small load. May it be some kind of starting weakness? Can be tremor of my legs also caused by some weak muscles?
Also I've noticed that shoes which I was always wearing tightly in the past, became bigger for me.. So it is definitely that my feet became thinner..

I apologize in advance for all my questions, it is just hard and anxious time for me to wait till I get some diagnosis. My neurologist told me that in some cases it might need more than a year to make a right diagnosis..

All your answers and opinions will be appreciated!

 

[KarenNWendyn]

Bilateral Hoffman’s sign can be a normal variant. Spine issues affecting the legs might cause tremors.
As Laurie said, a physical therapist might help you, but I wouldn’t worry about ALS.

 

[Dmitry12345]

Update.
I had an EMG again yesterday, doctor tested 3 muscles, results are below:
Right tibialis anterior - 6 fasciculations, Muap's duration and amplitude normal, polyphasic potentials - 60%
Right thenar (which is twitching for more than 3 months always in one spot) - 1 fasciculation, Muap's duration and amplitude normal, polyphasic potentials - 50%
Left calve (which had a lot of fasciculations and also fibs and psw 2,5 months ago) - 8 fasciculations, mean amplitude 828 at norm 700 - increased; max amplitude 3418 at norm 1500 - increased; duration 11.4 at norm 9.9 - increased on 15%. No fibs and psw were detected.

So as I understand important thing is that fibs and psw in calve have disappeared somehow, but now there are signs of reinnervation.
I can't understand if there is a sign of chronic denervation now?
It seems to me that this EMS is still abnormal and I don't know if I can rule out ALS with this EMG or not?

Please help me to understand and thank you in advance!

 

[KarenNWendyn]

Your EMG is not consistent with ALS. Also, your strength was normal when tested by a neurologist and you don’t have any muscle function failure.