Foot drop and more EMG tests

michelleroberts

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Had foot drop for a year now- had MRI of brain, neck and spine and got all clear. Had EMG/Nerve study tests in March this year but just on the foot drop leg which was inconclusive. I had EMG/Nerve study two weeks on all limbs, stomach and neck ago and got results verbally from neurosurgeon. He said he cannot rule out ALS/MND and to repeat the test in two months unless I have more symptoms. I have asked for hard copy of test.
Besides foot drop and not being able to walk far I have twitches in the foot drop leg and the other leg but not many.
The tests showed fasciculations in my upper limbs but I have not felt these.
Is it normal practice to do a repeat test and should I seek another opinion as two months seems a long time to wait.Thank you
 

Nikki J

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This is somewhat hard to answer without seeing the emg but generally if there is something questionable on the emg that they want to see iit progresses or not the usual interval is 3-6 months. When you are looking for progression the emg is not going to change very suddenly. If the neurosurgeon said that though why are you not being sent to a neurologist? ALS is not a surgical issue so you should be evaluated by someone whose specialty is at least medical neurology. Depending on how suspicious the emg is you might need an mnd specialist to sort it out
 

michelleroberts

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Sorry I meant neurologist not neurosurgeon- I would have thought I would have had more symptoms in a year? I have been in touch via my GP about a referral to MND clinic in Leeds- thank you
 

michelleroberts

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B71A301A-2503-49FE-83DA-E5A5C8B62482_1_201_a.jpeg
 

Nikki J

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Thanks for sharing. It does seem as if your neurologist’s plan is appropriate. While there are abnormalities they are not close to meeting ALS diagnostic criteria So repeating and looking for progression after an interval is what usually happens. Your doctor actually sounds pretty proactive with that short an interval. I don’t think it is a given that this is going to be MND so don’t give up hope it will turn out to be something else
 

michelleroberts

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Morning,
Went for results of EMG/Nerve study tests and been referred to MND/ALS Clinic in Leeds, I have attached results, I am finding them more difficult to understand than last one - can anyone help, thank you xx
 

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Nikki J

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I am sorry that you didn’t get cleared. I am sure the doctors at Leeds will explain everything on detail and probably do more tests

ALS is a disease with acute and chronic changes on emg and those changes need to be in multiple areas - not just in muscles in one nerve area. You now have evidence of that in your legs and they saw some minor abnormal in your arms that if those were the only findings wouldn’t suggest ALS.

they also note that other causes need to be ruled out especially spinal issues as if you had several areas in your spine compressing nerves it could look like this. Another part of the criteria for ALS is ruling out other causes so this is appropriate. Have you had or did they order mris of your neck and back? Leeds will probably also want to do some blood tests to rule out odd mimics.

you haven’t mentioned any upper motor neuron signs on exam. If you don’t have them that adds more choices to the differential. If this is ALS your slow progression and the fact that it will have taken over a year to reach diagnosis are hopeful signs that you will continue to progress slowly
 

michelleroberts

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Thank you for replying. Hopefully Leeds will explain the results in detail. I have had MRI of brain, neck and spine and these came back ok.
I have also had bloods done for mimics and they came back ok but perhaps Leeds will do more.
My upper body strength is good and no problems as such apart from them aching from overuse.
Looking at these do the results look worse than my previous EMG?
Thank you again for looking at my message.
 

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Don't confuse UMN and LMN with upper and lower body, they are not the same thing.
I hope you get answers soon and it is something other than ALS.
 

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I don't think the results look worse. I would have expected to see more active (acute) changes and more reduced recruitment. But every EMG looks different. Also, a lot depends on the findings of your clinical exam. Besides the foot drop, did they mention brisk reflexes? Upper signs are spasticity, clonus, brisk reflexes and can also be weakness. They're looking for clinical weakness in areas that match the EMG and changes that are widespread.

I'm sure Leeds can explain the basis for the summary and what comes next.

Please let us know.
 

michelleroberts

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Thank you for replying.
I do have brisk reflexes - very brisk on knees and brisk on arms.
The foot drop is so debilitating along with the leg weakness.
My neurologist called yesterday and is hopeful I will have an appointment at Leeds MND clinic before Christmas.
I will keep you updated, thank you.
 

KimT

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I’m glad they’ve getting you in so soon. I hate waiting.
 

michelleroberts

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MND appointment at Leeds is not while 2nd February - not too long away I suppose.
 

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Great, that's only a few weeks. Let us know how that goes.
 
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