Need advice on EMG results

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Bas

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Please help! I have had overall body twitching which started about two months ago. Around the same time my throat started to get very tight and I have since developed some swallowing problems. I can eat but need to swallow food a few times and take it down with water. I also have some muscle pain left calf and don’t feel as strong as before. This is the leg which has most of the twitching now. I went and saw a new neurologist at our city hospital and he conducted the EMG which was listed as abnormal. Please have a look and let me know what you think. I greatly appreciate any help you can provide.
 

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As it says no evidence of ALS /MND. It looks like you might have an elbow problem. Is that not what you were told?

emgs can be abnormal in many ways most ,like yours, are not ALS and not life threatening
 
Yes I was told that but I was concerned because EMG was only conducted in left arm, leg and thoracic paraspinals. It was not conducted on the right side as the NCS was. Also I am concerned about where he states Large MUP. Ulnar shows increased insertion activity, 1 Fib. I don’t understand the details on that line.
 
There is nothing wrong with the EMG/NCS being conducted in different regions. That decision is based on where the doctor thinks problems should be ruled out. The very good news, news that no one with ALS receives, is that there is no sign of nerve or muscle damage in the places you report issues.

The words on the ulnar line suggest that you have damage to the nerves in your inner forearm, very common esp. with people who do lifting, texting, keyboarding, etc. You can ask about hand therapy if there is continued pain or numbness. And it doesn't hurt to recheck your ergonomics whenever you move or rest your wrist against a surface.

For further questions, please check with your doctor.

Best,
Laurie
 
Thank you Nikki and Laurie for your reply.
I have called the neurologist to get further clarification. He is not a neuromuscular specialist. Are there any specific questions I should be asking him?
I’m more worried because I have had soreness in this arm and hand for a few weeks now. The fact that the report indicates MUPs and increased insertional activity as well as Fib has me concerned. Does this not mean chronic and active denervation? Are the MUPs identified by the amp and dur?
It’s just a lot to deal with as I’ve already had childhood lymphoma and breast cancer a few years ago. I was finally starting to feel better but this worry has taken over.
Also I have had swallowing difficulties but the doctor refused to insert needle under the chin.
Any guidance would be greatly appreciated.
 
I just spoke with the doctor and he said in the Summary section under Conduction Studies there is an error and it should read “reduction in amplitude in the left ulnar sensory study”.
He feels that this is an ulnar neuropathy that has possibly been there for some time. I told him I was concerned about the Fib and he stated that this is normal for ulnar problems. Is this true because I have not read that anywhere?
He said he tested the surrounding muscles and they were normal so that’s why he thinks it’s an ulnar injury.
As for my swallowing issues, he said he is not comfortable testing my chin/neck area but doesn’t think I need it. He said if I want he can refer me to a specialist at Sunnybrook Hospital in Toronto. At this point I’m not sure what to do. I do have an appointment with an ENT next week.
Also I’ve been on Pantoprazole since mid October because of tightening in my throat. It has only slightly helped but it’s after this that all of these issues started. My endoscopy came out clean with no problems.
 
That makes complete sense yes and ALS is a disease of widespread acute and chronic denervation which you absolutely did not show
 
Thank you again for your reply. My concern is that I have been having swallowing issues and my tongue feels weird like I’m not talking properly. I asked my husband and he says I’m not slurring.
The twitching started all over but is now mainly confined to legs and sometimes the arm and neck/face area.
Should I be concerned that I didn’t have the bulbar area tested?
I have read the stickies as well.
 
PPIs don't agree with everyone. Ask the doc who prescribed it if you can try a different one, or a different class of drug. It's not normally used for a tight throat. Even if you have reflux, it's not necessarily something to use long term.

Everything you heard about the EMG is true. Hydration never hurts. An ENT can rule out serious issues relative to your throat.

Again, nothing to do with ALS.
 
Last night I had continuous twitching on the left side of my body, leg, foot, arm and left side of neck. Today that side of the neck feels extremely tight.
I started to take Escitalopram today for the first time. Is it possible that these can have a negative effect on me if any of my symptoms are related to anything neurological?
 
Hi Bas,

This is not a site to garner diagnosis for your general aches, twitches, and pains. It is a site for those with ALS, their caregivers, or those going through an ALS diagnosis. You have already been through testing that cleared you of this disease. Anything further, you must discuss with your doctors.

Best of luck to you and take good care. Stay safe
 
SSRIs can affect sleep, but generally not on night 1. Usually it takes weeks to have a positive effect. If you have questions about the effects it's having, positive or negative, you can discuss with your doctor or their nurse. Sometimes one SSRI works better than another for certain people.

All the best.
 
Thank you all for your replies. I really appreciate you taking the time.
 
I do have another question. I am still concerned because I have been unable to find anyone else who has had a similar EMG on this forum and not diagnosed with ALS. It seems that my ulnar nerve line shows both acute and chronic denervation. Is this right? I believe I am reading it correctly. I have twitching in all limbs but especially this arm and both legs. I also have a lot of soreness in both arms.
Thank you in advance for your responses.
 
are you worried about that isolated fib? We see it very often here in people with a localized issue like yours and none of the people I can remember ended up with ALS. It happens eith back issues , neck issues, elbow issues, wrist issues etc
 
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