Help interpreting EMG

[Carlos H]

EMG results

Hello:

I went to my neurologist with the following symptoms: progressive spasticity, extending from left hand to left foot over the course of a year and a half. Lack of balance and clumsiness. No fasciculations or atrophy.

My EMG results arrived today. I will be translating to English so I hope I do not mess up. Would you help me understand what might be going on? I don't have an appointment with him to discuss them until after the Holidays...

"EMG:
Slowness of speed in the conduction at MSI, suggestive of incipient mononeuritis multiplex and / or polyneuropathy, of low intensity.

In MSD, slowness of median sensitive nerve at its pass through the carpal tunnel, compatible with carpal tunnel syndrome of mild intensity.

In MSD: 1. Chronic motor radiculopathy C7 of low intensity. In MID: Chronic motor radiculopathy L4 of low intensity. In MII: 1. Acute motor radicular suffering S1 of low to moderate intensity.

Except in the myotome C7 right and S1 left, no signs of acute denervation that could be attributed to the presence of an MND. "

Does this mean that it is unlikely I have an MND or that signs in two myotomes indicate that perhaps I am developing lower motor neuron signs and thus could be attributed to an MND diagnosis? Thank you for your help.

 

[lgelb]

Re: EMG results

Do you have the full report, with a table of results in columns? There should be names of muscles, not just vertebrae, in this report.

From what you write, the "unlikely you have an MND" version is more likely.

Do you have a family member with MND as indicated in your profile?

 

[Carlos H]

Re: EMG results

Thank you for your quick answer.

No family members, just a mistake in my profile.

This is all I got, unfortunately. Supposedly, everything else was normal, aside from these findings.

 

[ShiftKicker]

Re: EMG results

Carlos, have you spoken to your doctors? Surely they would know more, given they have your full medical history and are the ones who referred you for both testing and received the report? What have they stated is the next step?

 

[Carlos H]

Re: EMG results

Unfortunately, I just received the report... I don't have an appointment with my doctors until after New Year's Eve

 

[KarenNWendyn]

Re: EMG results

It sounds like you have pinched nerves.

The part of the report that states “no signs of acute denervation that could be attributed to the presence of an MND, " means the doctor felt a motor neuron disease (ie ALS) was unlikely.

 

[Carlos H]

Re: EMG results

Thank you. I called my doctor and she did confirm that the EMG did not show LMN damage compatible with ALS.

However, she also said that my progressive, debilitating spasticity and clumsy walk cannot be attributed to pinched nerves. My impression is that she thinks I might have PLS (since MS and Atyplical Parkinsonism are ruled out). However, it is probably soon to say.

I have an appointment on the 6th and will probably be able to know more later on,

 

[Carlos H]

Re: EMG results

Hello,

I do not have the table of results, but I received a new report... It says that some of the possibilities are "PLS, Lewis Sumner, and combined subacute degeneration." I will post now the summart (again translating from Spanish) and I will appreciate help interpreting what these EMG findings suggest:

"slowness of the velocities of conduction in MSI suggestive of MM and or PNP, distal and asymmetric demyelination of low intensity. IN MSD slowness of the median nerve in carpal tunnel, chronic radioculopathy at C6, C7, and C8-T1. Moderate signs of denervation with fasciculations at C7"

How bad is it that there were signs of denervation with fasciculations at C7?

 

[KarenNWendyn]

Re: EMG results

Again, that suggests impingement of the C7 nerve root. This can lead to denervation in that region, but this is very different than ALS.

ALS is degeneration of motor neurons in the brain and spinal cord. Your tests suggest a problem affecting nerves after they have exited the spinal cord.

 

[Carlos H]

Hi. Could someone please help me interpret this EMG? Does it mean I have ALS?

https://imgur.com/a/3EFI6uR

According to the summary, there is no acute denervation. The doctor who performed the EMG said there were no signs of ALS, but the doctor I saw today for a consultation said there are.

 

[Carlos H]

Some other details... On a clinical examination, I have mainly PLS symptoms and had a clean EMG recently. The doctor who did the EMG said that it did not look to him that there was enough evidence of second motor neuron involvement, all the more when he checked my strength, muscles... etc and they were fine. I noticed there were no psw or fib. However, I took the results to my neurologists and he said that this shows evidence of systematic LMN damage and changed my diagnosis... I don't know how people feel. On a clinical level, I have no weight loss or atrophy.

 

[KarenNWendyn]

Carlos, in one of your previous posts from a couple weeks ago, you said “I called my doctor and she did confirm that the EMG did not show LMN damage compatible with ALS.”

In your current post, I assume you’re asking about the same EMG, not a new one.

Diagnosis of a motor neuron disease requires looking at the overall clinical picture in terms of history, physical exam, lab and imaging studies, and EMG. EMG can suggest a motor neuron disease or rule one out (if it’s normal). As you do have some abnormalities on your EMG, I think the best approach is to discuss with the neurologist(s) you are seeing.

You apparently received conflicting information from the last neurologist you saw and the one who performed the test. I would ask the 2nd neurologist why they feel there are signs of ALS and how do they want to proceed.

Sometimes in ambiguous situations, the neurologist will want to re-examine you in several months and repeat the EMG, because part of diagnosing ALS requires documenting evidence of disease progression.

Your other option is to seek yet another opinion.

 

[KarenNWendyn]

Also, what did the second neurologist say about your physical exam? Any signs of muscle weakness, spasticity, hyper reflexes or abnormal reflexes? PLS can’t be diagnosed without the spasticity and hyperreflexia. ALS can’t be diagnosed without demonstrating weakness and at least some upper motor neuron findings.

 

[Emanol]

Take everything I am about to say with a grain of salt.

This paper has been very useful for me, as I am also struggling with my father's doubts between PLS and ALS: https://academic.oup.com/brain/article/124/10/1989/333489

Of the 20 patients studied who had PLS, a significant number of them had EMG results that resemble yours, with decreased recruitment of MUPs, as well as evidence of positive sharp waves (at least six patients had them in two areas, just like you). Accordingly, I think that a lot depends on the clinical examination. The EMG is abnormal and you should keep on working with the doctor, but it is not clear to me that these results would necessarily show that you do not have PLS, all the more if one of the doctors thought so.

Keep in mind that ALS and PLS seem to be more of a spectrum: it's important to enjoy life (and the lack of LMN signs) while one can, without fixating too much on which is the first letter of the acronym that defines our condition.

 

[Carlos H]

Thank you for writing. I really appreciate it.

I have spasticity and hyperreflexia. It does not seem that I have much weakness, at least not very clear.