Fasics on emg?

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Ruggerhead

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Thank you for this site as it has been of huge comfort to me, and very imformative, especially for those of us in a bit of Limbo. I have had body wide fassics and other muscle symptoms for about 10 months now, mostly in the calves both sides, but all over at times. I had an emg done in March and that was fine, in that they picked up the fassics but the Dr said in isolation and not associated with other hallmarks of ALS, that they had a stable, benign look. All good, untill now.

IJust had another emg from a different neuro, and he said 'some neuro changes in leg and hands' No fibs or short waves it seems but the report says rare benign fassics found in both hands (benign). Report shows also no sign of ALS. But heres the thing, surely fassics cant have changed pathologically if they are not now indicating something else ie ALS, also they cannot be due to a root lesion as suggested (he is suggesting and old sports injury) as does not make sense as there was a sudden onset of these Fassic's and they are not getting better.

I have read that a new criteria now exists for potential earlier diagnosis in that it now places more importance on FP's than ever before. So is this now a normal or abnormal emg? I seem to be ok on in the clinical's in respect weakness, reflexes and atrophy etc, but that does not always follow either, as in some rare cases fassics have been known to come before clinical weakness and atrophied muscle. When I emailed the last neuro back who did the last emg, he said, 'fassiculations are different in ALS.' But didn't explain how? Do you have to show dennervation and reinnervation in the same muscle, and how does that show on Emg?

I just wondered could anyone shed a light on the fact that FP's may be slightly complex but still not be the type actually seen in ALS. I had hoped that a normal clinical exam with a normal emg would have been enough to quell my nerves, but it appears as if after nearly 10 months, its suddenly not so normal anymore, or perhaps is it regarded as normal in the context of ALS diagnosis?
 
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Nikki J

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Previous thread A Little confused?

please post ( deidentified) the emg summary and interpretation and the chart so we know what you are talking about. It is still true if you only have fasciculations on emg they are non worrisome. The newest criteria require either upper motor neurons sign plus a diagnostic emg result in one area or two areas on emg Upper motor neuron signs are found on exam. You don’t have them by your own report
 

Ruggerhead

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Here is the report, although main page says:

Slightly chronic nerogenic changes and fasiculation potentials in both tibialis anterior and left medial gastrocnemius. Rare benign fasiculation potentials in first dorsal interosseus bilaterally. No signs of ALS.

I cannot find the original Emg by another Dr but was told it was normal, except for fassiculations found in isolation, and without the hallmarks of MND.

In ALS terms is this latest emg normal ?
 

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Bestfriends14

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Congrats on not having ALS (as it clearly states in the conclusion) and confirmed by no ALS symptoms, no clinical symptoms, and multiple clean EMGs. Surely having been told multiple times no ALS, you would no longer be hanging around a site for terminally ill folks and their exhausted caregivers? You must be very relieved to be able to finally put this behind you. If you are not relieved, you should talk to a counsellor.

Best of luck to you and take good care.
 

Ruggerhead

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What I was actually looking for was an interpretation of the latest results, not just advice on seeing a counciller. It is ironic, that I am such a councillor and deal many patients that are/ have faced terminal diagnosis, including many ALS patients. I do have symptoms in , if you believe all the professionals who will tell you that 'fassiculation and cramps' can be an early symptom on there own, albeit rare. My Emg has changed since the earlier one, done 6 months ago, and I was asked to post it, to get some sort of explanation. I know that many of you are carers, and that is extremely difficult, and i have so much respect, I also council people involved in that role. A lot of people come on this site to try and get a greater understanding of what is going on with them. I have had a lot going on for nearly a year, and didn't expect to see any changes on my latest Emg, but there was.

It is hard just to just wait around for another 6 months to see if the changes are progressing or not. Sometimes Nuero's can be quite dismissive in that regard, and sometimes you have to advocate for yourself.. Obviously I am not a Dr of medicine, and so like a lot of others wanted to know more opinions. I should have asked more on the day, but it was only after I saw the report, i started to wonder if these findings in anyway pointed towards ALS.
 

Bestfriends14

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Could you please post the summary portion of the report with your personal info blacked out? Your neuro had already told you you don't have ALS, so if you don't believe him/her, I'm not sure you'll believe anyone here.
 
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affected

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Surely your doctor interprets the EMG to you?
The EMG is diagnostic along with the clinical examination, which you should be aware of if you work with PALS.
If you had ALS, and it showed obviously on that EMG, do you think you would not be called in by even a dismissive neurologist to discuss this?
Please do post the summary for us, and get an appointment with your doctor.
 

Ruggerhead

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Thank you both, for your valuable input, Affected your are correct re PAL's, although my mental health work is around coping mechanisms, and life expectancy, relationships etc rather than a diagnostic base. As it is also around other terminal or chronic conditions. To be honest, personally ALS was not even on my radar, until I noticed painless body wide twirching back in Jan, and muscle tightness.
Yes, I have heard that it is a clinical diagnosis, but then on the same hand you hear that Emg is the golden test.

I think I just got a shock when a person very close to me, who was told in pretty certain terms by his neuro that this is' 100 percent not ALS, is now telling me that based on another emg, with changes done last week, that is exactly what he now suspects, and he is being referred immediately to the leading ALS consultant. Given my latest report, and the fact that it seems more significance is placed on FP's on an Emg, is my Emg now regarded as abnormal in an ALS context.

My latest emg was done in a foreign clinic, and yet to here back on email. I have tried to contact my original nuero, who did the first emg, and told me that it was normal, just to find out if chronic changes, now picked up on the new EMG mean this now is a dirty EMG, but he is presently away on leave.

I did notice that in the emg part it says mild-mod inactive changes and if ALS was present would it not have to be active? I have not had any back problems and had a scan, so don't see any reason to see root lesion, and cant see if it was chronic why that was not picked up in the original.
 

affected

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Please post the summary.
The EMG is gold standard, but it is for professionals to interpret along with clinical examination.
 
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