Marta’s question

[Marta1985]

Hello, I would like to ask you if acute denervation always presents as fibrillations or positive waves or can it appear only as fasciculation, I understand that until a few years ago fasciculation in the territory of chronic denervation was not interpreted as acute denervation but in the new criteria fasciculations may be the early sign of acute denervation. Could only fasciculation be seen without positive wave or fibrillation and be the sign of an acute denervation if it occurs in the area of chronic denervation?

I ask you this question because I have been with fasciculations included in the tongue for three years but in the legs that are continuous, although they are not seen, the first two emgs were clean but the third appeared chronic axonal lesion (amplitude and duration increased, with slight loss of motor unit and a fasciculation in the territory of the already compensated chronic axonal injury.

I understood that there are women that start in a single territory, they did a 32-muscle emg and only affected the abductor Hallucis with this chronic axonal injury, but I am afraid that fasciculation in that territory could be the beginning of an acute denervation and Give continuously acute and chronic denervation at the same time. It's been nine months since the last emg and I still have no weakness. IS it possible that it is ALS?

Thank you very much

 

[lgelb]

Fascics only on an EMG, with no PSWs or fibs, are not considered evidence of denervation, but rather suggestive, depending on the clinical picture, of BFS (benign fasciculation syndrome). Even the third EMG, if it showed abnormalities in only one muscle, and no acute denervation, is not evidence of ALS (fortunately!)

32 muscles is a lot. After 3 years, an EMG that sees only a past injury in one muscle leads far away from any MND.

So I don't know why you would think anything you've mentioned would be the beginning of anything, least of all ALS. If this anxiety affects your daily life, that's what I would look at first.

Best,
Laurie

 

[Marta1985]

Good afternoon:

I ask you for help with my emg please, I am having a very bad time this afternoon after reading the story of a member of this group who did an exhaustive emg on several muscles and only had an upper limb affected, when he repeated it After more than a year and a half, only in that muscle he had generalized lesions in the muscle that was bad.

Since 2017 I have presented generalized fasciculations, mainly in the legs, the first two emgs were clean but in the last emg performed in November of 2019 the abductor hallucis muscle appeared with a chronic neurogenic pattern (amplitude and duration increased) and a fasciculation in the area, the neurologist thought it was radiculopathy but I had an MRI and there is no protrusion or hernia

I go to a neuromuscular specialist on the 26th of August and I do not know if he will repeat the emg but I am terrified after reading the member of this forum that only had affectation in one area of the nerve and then it was extended.

Laurie left me calm when we spoke the other day when she told me that most people came to the emg with weakness (I have no objective weakness but heaviness) and the few who had findings in their emg within a few months already had weakness but I have seen that it took that boy more than a year and a half to see the changes in his emg and that he started in a localized area and not in múltiples areas
I am afraid, what do you think of my emg, should I have weakness after nine months since the last emg?

a hug and sorry for the inconvenience

 

[affected]

Gosh which member are you talking about - a solid reference would make it far easier for us.
Looks classically clean, don't push uphill.

 

[Marta1985]

I think it is the story of ElinciLA, I saw that her emg at first was affected in the upper limb and then it took almost a year and a half to have the results in another emg when other muscles were already affected but my English is not too good and I do not know if I have understood his story well. I understood that for 17 months there was no marked weakness, am I right or am I wrong about the translation?

 

[lgelb]

I think you mean EricinLA.

It is not productive to try to cherry-pick details from a single other person whose clinical context you could not possibly know well. As you mentioned, I have already stated and will stand by the assertion that based on your EMG and story, there is no reason to worry about ALS. As you can see, others agree.

Best,
Laurie