Help interpreting EMG

[Carlos H]

I am just confused... I thought that the presence of fasciculations was not as important as fib/psw. I have what the summary calls "isolated fasciculations" in almost all areas, but I have no fibs. (this after approximately 2 years of symptoms). Can one make a reliable diagnosis of ALS based on a EMG that shows no fibs?

 

[KarenNWendyn]

If your strength on physical exam is determined to be normal by a neurologist, you do not have ALS. I wouldn’t worry about the fibrillations.

In terms of PLS, maybe one of our PLS experts here can weigh in. Is your most recent neurologist a neuromuscular disease specialist? If not, then we would recommend you see one. It’s hard to answer all your questions here.

 

[Carlos H]

No, my current neurologist is an expert on epilepsy and migraine. Here in Spain it's harder than other places to have a neurologist that is specialized on your particular problems, since we are assigned one randomly and have to stick to that, so to say.

 

[KarenNWendyn]

I’d think there would be a neuromuscular disease specialist in Madrid. There must be a university medical center there. I really would suggest that opinion. I’ve seen and heard of neurologists who were not neuromuscular specialists misdiagnose when it comes to motor neuron diseases.

 

[lgelb]

Even though you are assigned a neurologist, you can request that s/he consult with a neuromuscular expert, sharing your records. There are several centers in Spain where such consultants can be found.

 

[Carlos H]

Thank you everyone. I will definitely seek another opinion from a neuromuscular expert.

In the meantime, what do the people who have experience reading EMGs think? Which were the most common findings in your own EMGs?

To be more precise, for what I've been reading this is necessary for a diagnosis: "The needle EMG is the most important study in determining diagnostic certainty of ALS. Acute (denervation evidence via presence of PSW, fibrillations, and FPs) and chronic neurogenic changes (as evidenced by decreased MUP recruitment with rapidly firing and reduced numbers of MUPs, as well as large amplitude, long duration MUP) is required for diagnosis of ALS."

I have FPs (everywhere but in the tongue, trapezius, and interosseus), scattered PSW and decreased MUP recruitment, but I have no fibrillations or long-duration MUP. I also have no clinical signs of LMN involvement (weakness, atrophy, weight loss, or visible fasciculations), but I have clear signs of UMN involvement. How relevant are the results of this EMG in the opinion of those of you who have lived with the disease? I will reiterate that I have more than two years of symptoms, so this is hardly the case of an early-disease EMG.

Thank you

 

[ShiftKicker]

Mod note- merged threads. Carlos, if you could keep posting on this thread only and not open another. This keeps all your posts in one place and makes your history easier to read for members here.

 

[KarenNWendyn]

Carlos, I understand what you’re asking in terms of EMG interpretation.

This is where you really need a specialist because it is not straightforward. The specialist will look at the big picture and interpret your EMG in the context of your history, physical exam, and other test results. This is what you need. It is not the sort of thing that we can do for you on a support and help forum.

 

[Carlos H]

Well, thank you for the help. I signed up for a third EMG on January 17th...

I am just so confused by this:

"No spontaneous activity of denervation. Motor Unit Potentials show duration, amplitude, and PP within the limits of normalcy. Absence of acute denervation, some isolated fasciculations in most of the muscles explored"

But then the doctor told me this is consistent with ALS? I don't get it.

Well I will have more information hopefully in the 17th... I just wish I knew a little better how to interpret this

 

[KarenNWendyn]

Carlos, I hope the doctor who performs your 3rd EMG is a neuromuscular disease specialist, because a proper diagnosis will involve such a specialist integrating the test results with the history and physical exam. The good ones generally like to perform their own EMGs.

This will be the person who is best suited to answering your questions. There’s really not much point in posting here until then.