Muscle spasticity concerns

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Bestfriends14

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I'm sorry you lost a parent to ALS, but may I ask why you are asking strangers on the Internet to second guess a neurologist's opinion? The report clearly states that you don't have ALS, so I'm sceptical of you believing anyone here if you don't even trust someone with 15 years post secondary education in the field of neurology. Your symptoms, clinical exam, and EMG all point to one thing: no ALS. A big concrats to no ALS; I hope you realise how blessed you are to have your physical health. Anyone here would love to be in your position. Lucky you.

Take good care and good luck to you.
 

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It is not in the least concerning for ALS (present or future), Julia, but as noted on the report you evidently have spine changes that should be looked at with an MRI, so it's good that's happening. Most likely you will be referred to a physio after that.

As to the report, see the "N" for normal across the amplitude, duration and polyphasic potentials columns (Amp, Dur, PPP) for each of the muscles tested? Paired with the rest of the data, these normal values demonstrate why your neurologist was able to tell you that ALS is not something you need to worry about.
 

Julia1234

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Thanks for your responses and care, it is much appreciated. I did feel bad after my talk with the Nuero, perhaps I could have phrased my questions differently. I do want to say I was able to get an appointment very quickly, and the staff was friendly and helpful, and I got my results the same day and for that I am grateful. I think there was an appointment after me that he might have been late for and in a hurry. I am a very logical person so I guess maybe I thought he would review with me on how he arrived at his conclusion. Also reading up on EMGs there is a lot of technical language I try to weed through that doesn't always correlate to what I am looking at on the report. I did find publications that mention fibrillations, reduced recruitment, cramps and PSW as generally "bad" findings and the first pathological problem referenced is "as seen in motor neuron disease". I understand they happen from time to time in healthy people but that it occurred in all 3 muscles at a +2 in 2 seems very concerning. I see that the "normal" values on MUAP indicate away towards chronic denervation for now at least but I guess my followup question on that, is in ALS patients is fibrillation, psw cramps etc the result of chronic denervation or vice versa? Meaning if they show up on the report now is it unlikely that anything other than radiculopathy is the sole cause? I do have back problems too so I know this is a contributing factor however my chiropractor seemed to think they were not abnormal and said my spine was not fused just some discs were jammed a little. (Ironically I haven't really felt any cramps either but I noticed my calves seem to "pulse" or twitch lightly literally once every 30 seconds now, I wonder if that is it?). Anyway thanks again for all your input.
 

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Hi Julia
You truly need to take your questions back to your neurologist. The EMG is interpreted in combination with clinical examination.
You need to ask your doctor to either diagnose you with ALS or explain why you truly don't have ALS and you need to then accept what you are told.
Make an appointment, gather your questions and have them with you in writing.
Get the answers you need and move to whatever the next step is.
You don't have the medical training to ask us questions and evaluate the meaning of your EMG, but your doctor has an obligation to explain it all to you fully.
I hope that helps you know exactly where you are at.
We don't have any doctors here on the forum.
 

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Fibs, PSWs, fascic potentials and/or reduced recruitment can be seen in a number of conditions, including but not limited to radiculopathy and ALS. Without MUAP abnormalities, none of these point to ALS. For us to worry about ALS on an EMG at all, both sides of the table you are looking at would have widespread abnormal findings.

As Tillie says, you are evidently falling into a rabbit hole with reading -- EMG interpretation is complex -- a specialized neurologist does these -- and requires clinical correlation -- so your doc on the ground is indeed the best one to explain what these results mean for you. I can only say confidently that they do not suggest ALS. That would be like looking at a dented car and concluding it was out of gas.
 

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I wanted to ask my nuerologist these questions of course but he specifically stated he had already given me his diagnosis and anything further needed to be discussed with a neuromuscular specialist. I am trying to get in with one but it's a heck of a wait. My mom was limb onset so that is where I was focused and since then I've started to have cramps, muscle aching and nonstop twitching. It just is not normal for me. I've also now noticed my voice is different. Others are saying it too. It is weaker, a little raspy and seems to be more nasal. I didn't really cough much during covid either, although it is mentioned inflammation can affect your vocal cords. I read a few about bulbar onset started with nasal voice, including a member of the long covid forum who's fiance had a nasal voice one month after covid then went on to develop slurred speech and eventually dx with bulbar onset. The logical side of me knows someone was bound to be diagnosed with ALS after having covid like you said rabbit hole but my symptoms are messing with my head. I noticed when I sing it is very nasal as I feel the vibrations in my nose like when I say uuuh. Is that normal, I can't seem to find much info on it? Can developing nasal speech be due to other causes than bulbar?
 

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Allergies, dry mouth/nose, and GERD, to name three. And anxiety definitely contributes to the second one. Many people use a nasal steroid before bed and/or in the morning. Eating too fast, eating too much at night....

Again, if you had either bulbar or limb onset ALS, there would be EMG findings that you didn't have -- a very good thing!
 

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There's a million things that it could be but it's not ALS. You've already been told this. Many times. Quit chasing this disease and move on. You keep adding symptoms randomly with every thing you read and with every Google search. Let it rest already as you do not have this disease. Why in the world are you not grateful for this? I just don't understand.

I truly wish you the best but you need to let this go now. Good luck to you and take good care.
 

Julia1234

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Forgive me for posting again, I've been really feeling awful because of the covid and have not smiled much if at all. The EMG was only done on my leg, not my facial muscles. Today when I went to smile my face started trembling or tremoring and my cheeks started shaking. I can't seem to stretch my cheek muscles all the way to show my teeth they continue to shake. I'm very scared and dunno what this is. Is this a bulbar symptom?
 
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lgelb

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No.
Once again, and for the last time, an EMG is not going to be done for all the muscles of all four limbs + torso + bulbar muscles. So what wasn't done isn't a concern, because if it were ALS even muscles you thought were OK would not show up that way.

Closing this thread. Please do not open another. Your primary care physician is the one to consult and can steer you to someone who can help with your health anxiety.
 
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