help with interpreting the EMG please

[hesam]

Hi all,
My wife is suffering from her both hand's atrophy in thenar and hypothenar areas for about 1 year which has been confirmed by the doctors. ofcourse, her thumbs were starting to weaken from 3 years ago but we were negligent to those until the atrophy happened. she did some blood test, xray imaging and MRI and all were normal, after that she did the nerve conduction and EMG test which the result has come out now. can anybody help us to interpret the result of the EMG test and nerve conduction as we are very concerned about it. she is 37 years old.
Many appreciate in advance.

 

[lgelb]

This EMG does not suggest ALS, which entails specific acute (that she does not have) and chronic motor neuron abnormalities.

As noted, she may have a chronic axonal motor neuropathy. She should be seen at a neuromuscular center. Depending on more speciailzed studies that they may undertake, there may or may not be any kind of drug therapy available. The good news with that kind of neuropathy is that she would not likely become severely disabled.

As with any chronic illness, nutrition, hydration, sleep, and judicious exercise will be helpful, and if she has or develops problems with her feet, I would suggest shoes made for peripheral neuropathy sufferers, who often do better when shoes are worn at all times except for sleep. Even if her feet are not hurting her, supportive footwear is important throughout.

 

[hesam]

Many appreciate Igelb for your kind comment which was a really big peace of mind for me, as she does not still anything about her disease and I was wondering if it was ALS, how can I inform her. she is also suffering from hepatite autoimmune from 18 years ago and was born from family marriage.
so, why in the EMG report, it has mentioned in the first sentence that her electrodiagnostic finding indicated that she had motor neuropathy? is it different from ALS?
and what is axonal motor neuropathy? to be honest I am searching for whole day to get some insight about it but still confused whether it could be the same as ALS or not.
and really sorry for my too many questions.

 

[lgelb]

ALS is a motor neuronopathy, not a motor neuropathy. In ALS, the damage is in the nerve cells that make up the nerves. They die when they shouldn't. When there are no longer enough nerve cells for the nerve to control muscles any more, the muscles can't move any more.

In axonal motor neuropathy, a specific part of the nerve cell called the axon, which is like an antenna that transmits signals that tell the muscles to move, is damaged. The nerve cells do not die as they do in ALS, but they don't work as well as they normally would in a healthy person. So it is a less severe problem than ALS. It usually does get worse with age, but often slowly.

Not knowing which kind of hepatitis she had, hepatitis can cause nerve problems, especially if it was not treated well enough. There are therapies today that were not as common 18 years ago. I would see an infectious disease specialist if she has any abnormal liver tests or problems; she might benefit from IV infusions or some other treatment.

 

[hesam]

Thank you Igelb for your comprehensive explanation and telling me the difference about those type of disease. Sometimes these little nuances could cause a big concern as most of the people are not familiar with these expertise vocabularies. yes, you are right, perhaps Hepititis auto-immune and her liver disease cause the neuropathy because of the poor medication in Iran, as we are from Iran. she is taking Azathioprine 100 a day for about 18 years. Anyway, we have our first appointment on 8th of Dec with the neurologist and and can not wait what he is going to say. if there is any points about meeting the neurologist, please kindly let me know, as sometime we need to ask the specialist to prescribe the complementary medication like physiotheraphy or .....
And can you please give me an explanation about her EMG table, what do the reduced rows mean?
Many thanks in advance.

 

[lgelb]

It is always good practice to be re-evaluated for the AZA dose every year, more if there are changes.

The "reduced recruitment" can be for many reasons, many not that dangerous. There is mention that the neuropathy may be hereditary. Do you know if there are any of her family members with similar issues?

 

[hesam]

Thank you @Igelb for your response. can you please what is AZA dose you mentioned? No, we do not know anybody among the family with the same problem, but Like I said before, she was born of a family marriage.

 

[lgelb]

AZA=Azathioprine