New EMG Results

Status
Not open for further replies.

Michael949

Member
Joined
Oct 6, 2019
Messages
16
Reason
Learn about ALS
Diagnosis
00/0000
Country
US
State
CA
City
Mission Viejo
I wanted to get some opinions on my latest EMG for those of you who are more familiar with how they look.

I saw a new neurologist last month for worsening clinical symptoms - worsening weakness in left foot (can no longer move most of my toes on my left foot) and both arms, widespread atrophy on left side of my body (including my tongue), worsening fasciculations across entire body, and spasticity with cramping in both feet. The neuromuscular center at UC Irvine told me I had to see a general neuro before I see them and he must give me a referral

The EMG does not make any sense. The neurologist who performed it was not the same as the ordering physician, btw.

It found +1 positive waves in the Tibialis Anterior and Peroneus Longus but the dr who performed the EMG said it was a radiculopathy. These muscles correspond with the L4-L5 and L5-S1. My lumber spine MRI is completely normal and free of disc herniation, stenosis, etc...basically anything that can cause a pinched nerve. Two neurosurgeons have already told me they don't believe that is what's causing my symptoms.

Also, as he's performing the EMG, he tells me that he is impressed with the amount of visible twitching he sees from head to toe, yet no fasciculations are reported on the report.

So the general neuro asks me if I want the referral to the neuromuscular center or try physical therapy. He did not go into detail about much of anything. I told him I want the referral because even a pinched nerve in the lower back would not explain all the other symptoms in the upper body. He just said ok.

Based on what you see in these photos, does this report look typical of ALS? With such little information being provided to me and I likely won't get to UCI for a few months, I feel very alone in this process. Thanks.

IMG_0564.jpg



InkedIMG_0562_LI.jpg
 

Nikki J

Moderator
Joined
Mar 22, 2012
Messages
9,883
Reason
PALS
Diagnosis
04/2014
Country
US
State
MA
City
Boston
No. Not at all.
 

Michael949

Member
Joined
Oct 6, 2019
Messages
16
Reason
Learn about ALS
Diagnosis
00/0000
Country
US
State
CA
City
Mission Viejo
Thanks for your input, Nikki.

Would you feel comfortable elaborating? In other words, what would you normally be looking for in ALS that is not seen on this report?
 

Nikki J

Moderator
Joined
Mar 22, 2012
Messages
9,883
Reason
PALS
Diagnosis
04/2014
Country
US
State
MA
City
Boston
There need to be other abnormalities in the affected muscles in a specific pattern and it needs to affect a wider area. You have had these issues for over a year. your emg says no ALS.
 

lgelb

Moderator
Forum Supporter
Joined
Nov 5, 2009
Messages
9,432
Reason
Lost a loved one
Diagnosis
00/0000
Country
US
State
WA
City
Seattle
First, it is normal for the ordering neuro and the EMG examiner to be different. EMG is a subspecialty.

Second, this is essentially a normal study. So the list of what we don't see that we would see is ALS is long, and there's no reason to go into it.

Third, the fact that your MRI is clean and you have some evidence of a mild radiculopathy is not the smoking gun you seem to think, but very common. If you were a rubber band that was snapped and went back to normal shape, you were still snapped. But the rubber band still works. Our bodies are really very resilient.

That you have impressive, visible twitching and perceived weakness with normal EMG findings in those areas, without clinical fascics, makes it crystal clear that the twitches/perceived weakness do not reflect nerve or muscle damage, nor has UMN dysfunction been noted clinically.

These facts coupled with a normal spine MRI suggest that it's time to head to PT for a more palliative approach -- addressing the symptoms. You might have pre-existing range of motion deficits like weak muscles or joints, that are exacerbating a benign process, that a good PT can help reduce. Millions of people get PT every year, most walking in and walking out.

What's sure is that you're in the wrong place here -- a very good thing.
 
Last edited:

Michael949

Member
Joined
Oct 6, 2019
Messages
16
Reason
Learn about ALS
Diagnosis
00/0000
Country
US
State
CA
City
Mission Viejo
Ok, thanks Laurie and Nikki. Some good insights there.

Just want to answer a few comments you made - the dr who performed the EMG was not subspecialist in EMG medicine. He's just another regular neurologist. At this office, there are 4 but only 1 who apparently knows how to perform EMGs.

As far as clinical UMN involvement - When I was examined at my first appointment, the dr did note brisk reflexes in my left leg. And I do believe the cramps and spasticity are signs of UMN
 

ShiftKicker

Moderator
Joined
Mar 16, 2015
Messages
3,639
Reason
DX UMND/PLS
Diagnosis
06/2015
Country
CA
State
BC
City
Vancouver
Hey Michael, it's clear you feel like you have the hallmarks of MND, though others can not see the same- neither the specialists nor the folk here. While it may seem fruitful to you to continue to add things in this thread that you think argue in favour of, there's really not much the folk on the forum can do for you.

You've been provided a huge amount of insight, advice and time from the people here, plus what appears to be an actual actionable diagnosis of radiculopathy- is there something stopping you from pursuing symptom relief and continuing to focus on something others simply can't see as possible? If, after time with a qualified physio or following the treatment plan outlined by your medical practitioner, you still have symptoms they are concerned about, then it would be time to pursue other avenues.
 

Michael949

Member
Joined
Oct 6, 2019
Messages
16
Reason
Learn about ALS
Diagnosis
00/0000
Country
US
State
CA
City
Mission Viejo
OK, sounds like a plan. Thanks again to everyone who did take the time to help and answer my questions.
 
Status
Not open for further replies.
Top