Help Analyzing EMG Results

fazzi98

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Hello. I’ve been having a variety of symptoms since December and am hoping to have help while reevaluating my EMG results from February (left arm and leg). I read that Karen mentioned increased insertional activity is one of the abnormalities found in EMG studies for ALS. I had 4 muscles with increased insertional activity, as well as reduced amplitude in one nerve. Fasiculations were also found. My results are BELOW, and was looking for help in this analysis as I know very little how to read this test. Are these findings concerning? Sorry for the links, I was unable to upload pictures directly here.

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A synopsis of my journey so far:

Everything started with my right foot in September, when I felt a strong pain in the arch while walking. This happened several times, including a pretty bad time in October. My foot has never quite healed from this and feels very uncomfortable to walk on. MRI’s were normal, and I’ve gotten mixed diagnosis’s from podiatrists. One thought it was nerve related, while another thought it was muscular.

Twitching, crawling, popping of muscles all over the body started in December. It has become an everyday occurrence. I’ve had a strong pain in my lower right back, side and abdomen that extends into my groin. I have also had a very strange sensation of crawling near my groin area that has caused a lot of discomfort. This pain has been pretty constant, but has come and gone. It’s better some days, and usually worse in the morning.

I saw a Neuro in January and again in February. He had an MRI done of my head, neck, and lumbar spine. He saw no signs of MS and my physical examination was normal. I previously had an EMG for my foot (lower right extremities) done which was normal. He had me do a follow up EMG the following month for the left side of my body with a facility he was familiar with (results attached). He was not concerned with any of the findings and assured me my twitching is benign, and I showed no signs of ALS.

Since the end of March, I have had the sensation of something being stuck in my throat after eating. The right side of my neck had a lot of pain for a few weeks, but that has since subsided. I have had very little appetite since January, and have had strange sensations in my abdomen (twitching, pressure and pain in certain spots, feeling of something moving). I saw a GI doctor who had me do an endoscopy and later a colonoscopy, both of which were normal.

I know a lot of these symptoms do not explain ALS after reading through this forum. However, my discomfort that has been moving around my body along with the twitching has caused myself concern with no real answers so far. I’ve had a hard time even walking for more than a few minutes the past couple months.

Thank you so much for your time and dedication to this valuable resource of a forum.
 
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Nikki J

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Hi
The doctor told you the emg was not concerning.

Whatever Karen said about increased insertional activity, I am sure she did not say this finding in isolation was concerning. In ALS we see a pattern of multiple emg abnormalities in a widespread area. You do not have any other abnormalities on your emg and your other finding was on the ncs involving a sensory nerve. The ncs is usualky normal in ALS and anyway ALS is a disease of motor neurons not sensory nerves

Hope this helps
 

lgelb

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Everything Nikki says is true, and increased insertional activity occurs in some people in a variety of muscles like yours, for no dire reason, sometimes mild electrical abnormalities. However, I would make sure you have an HbA1c test for diabetes if you haven't.

The good news is that your EMG is normal in key aspects, taking ALS off the table.

Since you report difficulty walking, etc., I would go back to your PCP to discuss strategy and next steps.

Best,
Laurie
 

fazzi98

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Thank you both very much for the responses! That is definitely reassuring.

Laurie, I am curious why you suggest the diabetes test? I don't know if I've had that exact test, but I've had many, many blood tests from several different doctors over the past 6 months. I'm assuming the possibility of diabetes would have shown by now? My father is a type 2 diabetic so this is worth looking into, though.

I have still been concerned of what exactly "increased insertional activity" means. I read somewhere that it could be a sign of "early denervation" which obviously has not been sitting well.

I also forgot to mention that I am a 29 year old male. Thanks again for your time!
 

fazzi98

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Hi again. Was hoping for a follow up response to the questions from my last post. Thanks so much again for your time!
 

Nikki J

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Once again increased insertional activity as an isolated finding is not worrisome. Your doctor was not concerned.

It happens in some people as a normal variant. It could also mean the muscle was a little irritated. I don’t know where you got the bit about early denervation
 

lgelb

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Sorry, I thought I had responded for some reason -- must have absentmindedly closed a tab. Diabetes can be associated with some of what you describe. You should keep all your labs and tests together, anyway, and you can check whether you've had an HbA1c in the last few months.
 

fazzi98

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Hello again. I had a 6 month follow up EMG done last week (attached). It showed some abnormalities/fibrillations in my leg. They believe it is coming from my lower back. I do have a bulging disc, but it I was told before it shouldn't be touching a nerve or anything in the past.

I am confused because I had an EMG of my lower right extremities done in January, and it was completely normal (however it was done by a different doctor at a different facility). Should this be cause for concern? My neurologist wants to do another EMG in 6 months to be "100% sure", which obviously concerned me a little bit.

Still having issues with my right foot (podiatrist believes it's nerve related), along with body wide twitching, strong discomfort and pain on my right side, and some GI issues. Neurologist thinks my foot issue can be caused by my back, but that wouldn't explain the fasciculations or other symptoms. Thank you!
 

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Bestfriends14

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Hi there,

I am not sure if you mean to be on a different site as you mention pain, discomfort and GI issues. This is a site for ALS, which none of those issues have anything to do with ALS. As well, your EMG clearly states "no evidence of motor neuron disease". If you are looking for answers to general health issues, there are appropriate sites for those. Any further medical questions would, and should, be raised with your GP. The great news is that since your symptoms have nothing to do with ALS, you do not need to be on this site. Yay! That is an excellent thing. Best of luck to you and take good care.
 

fazzi98

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Hi again. I really appreciate the response and advice with my health.

I had a follow up with my Neurologist again. He mentioned again the need to do another EMG follow up in 3-6 months. He said their "suspicion of ALS is low, but we want to be sure." Obviously I now have it running through my head that while it's a low probability, there is some suspicion. My first EMG in January was normal, now my last two through this different doctor has showed different abnormalities. I'm confused since I haven't been showing any other typical symptoms, why they want to be sure and haven't completely cleared me of it yet.

We did MRI's of my thoracic and lumbar spine as well which showed some potential bulging discs in both areas.

Thank you again.
 

lgelb

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Minor abnormalities in EMGs would not be expected to track with symptoms. As you know, disk damage may explain the foot issues you are having, and these tend to feed/magnify other perceived issues. Also, EMG findings can relate to the skill, experience and equipment of the examiner, so slight differences in results between facilities is not uncommon.

You have presented every reason to keep following up on your disk disease, and considering PT if things get worse, but none for continuing to consider ALS -- wonderful news.
 
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