Fasciculations and abnormal EMG

[banjanti]

Hello everybody

I've consulted a neurologist about the pain I was experienced in both hands and feet, had EMG and NCS done and it showed abnormalities of denervation and some latency in median and cubital nerve
He put me on pregabaine, but then the twitching started, my big toes basically had a life of their own, I could see fasciculations under my skin
Asked him about it and he said to get of pregabaine, I've seen fasciculations diminish but they still bother me making me think they may be not really side effect, but something pregabaine just amplified somehow
Neuro is not really helpful, not a type that likes to answer questions, Gives the diagnosis and script kind of guy
I've asked him if fasciculations had anything to do with EMG findings and he just said "no"

For him it's nothing serious but I'm worried
What abnormalities would show in ALS suspicion?
Would neuropathic pain be present?

My reflexes are fine, no Babinsky, H reflex normal on EMG

I know it's very unlikely this can point to ALS, specially in my age of 33, but I'm still very anxious as I don't know what is causing my symptoms
I'll be seeing other neurologist soon, but until then I'll live to hear your comments

 

[Atsugi]

Hi Banjanti, welcome to our forum. I hope you never need to join us.

Don't worry about fasciculations or twitches.
The pain in your hands and feet is not ALS. But it's some kind of problem. Fix that.

Tell us more about "abnormalities of denervation."

 

[banjanti]

Hi! Thanks for your answer, I do hope I won't be here too long lol
Thanks for putting it like this

I have full EMG printout, but the description is pretty brief, it just says:
Signs of distal muscles denervation (see registry)

Diagnosis is a polyneuropathy

 

[Atsugi]

Polyneuropathy sounds about right to my under-educated mind. Somebody smarter than me would have to say if there is a link to ALS. I think any link would be rare.

 

[banjanti]

Thanks again. I'm looking for another opinion, hope I'll get it soon. I wouldn't consider it if it wasn't for abnormal EMG and twitching

Oh there was also mention of incomplete sum with maximum voluntary effort, but no wonder, when they were testing me and asked to make the effect I couldn't push more because of the pain needle cause, it just hurt so much
So I think that one should be redone after my pain is controlled to be reliable

 

[Nikki J]

If you have the whole emg printout there should be columns- the first thing would be the muscle tested See if you can find columns that translate into fibrillations, positive sharp waves ( psws) and recruitment. See what it says in these columns especially the first 2
Part of what you report relates to nerve conduction. Problems there generally mean something other than ALS
Denervation is concerning but without knowing whether there is acute as well as chronic and the extent it is impossible to venture an opinion as to whether you should be at all worried about mnd

 

[carex]

Are you diabetic??

 

[lgelb]

Polyneuropathy is a completely diffferent beast from ALS, and, as Carex points out, can be linked to diabetes, though not always.

This points away from ALS, which is great news. You may have a spine problem, diabetic complications or something else entirely.

Find a good (and more communicative) neuro and you should have a treatment plan soon.

Best,
Laurie

 

[banjanti]

I do not have a diabetes, however my A1C was 6.2 that considered pre diabetes sometimes, although my glucose levels are low, both fasting at 80, as well after meal. I even both a glucometeter for that purpose
All my other blood work is clean, inflammatory markers of ANA, ANCA and C reactive protein low our zero

I'm looked at my NCV and I see it, but still not sure how I should read it
I'll attach a photo of one nerve that shows latency according to description

 

[banjanti]

As for my EMG print I see no description, only graphs
I can put them online if anybody is interested in looking at them

From what I've found there is vast difference between chronic and acute denervation, acute may lead to ALS suspicion, chronic not so much
Unfortunately I don't know how to read the results and neuro is not really cooperative, he'll probably find it offensive for me to ask about something that is his specialty, not mine
I won't ever blame him, I'm university educated person and I know how annoying can the layman Google-degree person can be
I'm difficult patient, I need to KNOW, otherwise I'm hard with trust

I have my reasons not to trust medical system too much, it's not of a very highest steward in the country I live that is Bolivia in South America
I got a chest xray with pulmonary fibrosis once here, that was total nonsense as I later discovered
But I guess you can't screw up EMG testing?

I'm going back to my home country to look for another neuro and see what's wrong with me
But in the mean time I'm concern, I try to be as much rational as I can, but having that abnormal EMG doesn't help my sleep

Thanks for any of your time spend helping me here, I know how insignificant polyneurophaty is compared to ALS, I just hope it's the right diagnosis