My neurologist ordered an EMG. Some advice

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mxuruguay

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Dear all

I feel terrible for taking your time and thank you dearly for the work you do here. But im in need of some advice and thought someone may be able to help me

Im 34 y/o male from South America. For the last 2 months I ve had constant fasciculations all over my body as well as some weakness in my lower right arm (some difficulty moving my arm like brushing my teeth or holding heavy stuff like glass bottles) and some pain in my arm. I was referred to a neurologist who found good reflexes and normal movement and no spasticity but indeed notice less strength in my right arm (though he said it was mild) and the fasciculations all over, particularly and strangely my legs. He offered me an EMG and an MRI. When i asked about ALS he thought it was unlikely because of no clear clinical signs but he wouldnt rule it out just yet. He also said pain is not a common thing in ALS so that pointed away.

I will have the EMG in a few days. My question is: can a person have a clean EMG with widespread and constant fasciculations? I ask because is i dont want to get a test that just gives me anxiety and doesn't add new info other than the non stop visible fasciculations. Can this test really rule out a something like ALS even in this widespread non stop fasciculation situation?

I thank you in advance for any thoughts you may have. Bless you all and stay safe.
 

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Sure can - twitching really means nothing at all.

Have a good read here and let us know your results.

 

lgelb

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Yes, it can, to both questions.

But to answer your question -- for the test to mean anything, you have to be emotionally prepared to accept a verdict from an EMG that there is no evidence of ALS, if that is indeed the case. And, if the EMG suggests something else, that is a direction you have to be prepared to look at with your docs. Lastly, if the EMG shows no abnormalities, that too is something you will need to accept.

If you're not going to believe it, don't waste your/the examiner's time.
 

KimT

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My local neurologist has twitches in his legs constantly. He has had them for years. Blood work didn't reveal anything so he just accepts them.
 

mxuruguay

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Many thanks for the replies, this is now clear to me. I am more than ready to accept what the neurologist tells me as I trust him. And after the EMG and MRI if he says no ALS (and no anything else bad) I will happily move on with my life.

I shall post the results once I have them. Hopefully i can be one of those cautionary tales of people concerned with ALS because of twitches but had nothing after all the tests were done.
 

mxuruguay

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Update

My MRI showed hiernated discs and artrosis in c4 c5 and c6.

My emg - done in 2 legs 2 arms and face- showed clean results in both legs (except normal fasciculations in one leg) and clear in left arm and face. But right arm showed denervation in my lower arm corresponding to c7 c8. They tell me that this is consistent with the MRI damage even if its not the same vertebrae....they claim correlation between muscles and vertebrae is not 100% sometimes.

I ve never heard of that before though. Im slightly concernes about the discrepancy of the emg and MRI. But overall seems that im in the clear.
 

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congratulations that is fantastic news, you are definitely officially clear of ALS, no doubt about it.

Discuss your concerns of what you haven't heard of before with your doctor, we are not a general health forum and your doctor can give the only true explanations relating to your particular case and results. So happy for you!
 

mxuruguay

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Update 2

I went for a second opinion just to be sure. The second doctor says the cervical injury probably explains the denervation but the widespread fasciculations and the difference in nerve roots damage between the MRI and the EMG is strange.

Im told to wait and undergo some physical therapy and then repeat EMG but i haven't been given a timeframe.

Any comments on when it would be appropriate to repeat EMG to see if there are changes in the so far unaffected limbs?

Thanks
 

Nikki J

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when following up 6 months is usual sometimes 3 months. If you are getting treatment though that may alter the timeframe. If there is no follow up appointment planned then it is reasonable to call and ask the plan. It may also be noted in your medical record
 

mxuruguay

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Thanks Nikki for the info, much appreciated
 

mxuruguay

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Update 3

I asked my neurologist and he said next EMG can be scheduled in December

I aslo asked to give me a report of the first EmG (first they gave me only a summary that said partial denervation in right arm at c7 c8 level). Unfortunately im not sure what it means, here's my best translation to English;

Right arm

Extensor digitorum and abductor brevis policis - fibrilations and fasciculations with intermediate pattern and augmented duration

Brachioriadialis and firtst interossei dorsal - fibrilations with interference pattern

Triceps and deltoids were clean

Everything else was clean (left arm, legs and face) other than isolated fasciculations with normal patterns in couple of muscles in right leg (vastus lateralis and gastrocnemius)

Does this make sense to anyone?

Thanks and sorry for the follow ups. Im just being extra careful trying to understand everything they tell me
 
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