Normal EMG - Am I Officially Cleared of ALS/MND?

[CaptRich]

I’m currently a 29 year old male and back in December 2017, I started experiencing some constant twitching.

It mostly occurs in my lower extremities, but it occurred in my toes, feet, calves, thighs, arms, hands, etc. It really didn’t concern me, but it was pretty sudden and after a month I visited my Neurologist. The MRI was normal and so was the bloodwork. I actually worked with someone who got ALS, so even though I know it’s rare, I’ve seen how terrible this disease can be.

He said I passed the physical portion of my exam but offered an EMG. He performed a Nerve Conduction Study and an EMG in January 2018. I’ve attached the results. They came back normal.

Does that mean that I don’t have any ALS/MND? The reason I ask, is because I’ve consistently been twitching since my EMG. My report said there were no fasciculations, but they’re definitely there because I feel (and see) them. If my muscles weren’t actively twitching during the EMG would ALS/MND still show? Or would the muscles have to be twitching for anything to show up?

Appreciate your time. Thanks everyone.

 

[lgelb]

Twitching that you can see and feel is not the same as fasciculations on EMG. Even without what you perceive as twitching during the test, any abnormality would have shown up as the test addresses both the impulses generated by the nerves and the muscles' ability to respond. Yours is completely normal and you have no clinical weakness, so there is no evidence for an MND.

Sleep, stress, nutrition, hydration and exercise are all areas to tackle to try to reduce the twitching if it bothers you. A little magnesium lotion on any areas that are particularly bothersome may help.

Best,
Laurie

 

[Bestfriends14]

You have no symptoms of ALS and a clean clinical exam and EMG. Yes, of course you're cleared of ALS. Lucky you!

 

[CaptRich]

Thanks for the responses.

Another note - some twitching can be seen and other twitching can only be felt. They also tested one arm and one limb, I asked for both, but they said it was not necessary.

I just thought I would ask because it’s been 7 months and the twitching is still constantly there, but I was unsure how accurate EMG testing really was and if active twitching needed to be present.

I assume twitching wouldn’t be the first symptom, but from what I’ve read, twitching (with ALS) means the muscle is actively dying so it would show in an EMG.

Correct me if anything I said was incorrect. Thanks again for listening and understanding.

 

[IgorZilio]

EMG is very accurate. Fasciculations would've been recorded if they were present. My last EMG recorded fasciculations in ALL the analyzed muscles (cervical, thoracic, lumbar and bulbar regions, both sides), I don't feel them in 90% of those muscles, only in certain spots occasionally.

So 'active twitching' does not necessarily correlate with spontaneous depolarization of the lower motor neuron and the fasciculation potential seen on EMG. You don't necessarily need to be twitching for the EMG to detect the FP. With FP deep in the muscles, EMG is most certainly able to pick them up. If nothing was found, well then, it's because there really was nothing to find.

The 'actively dying' potentials are fibrillations and positive sharp waves. Fasiculations could denote axonal instability (malignant) in the presence of other changes, like altered motor unit potentials. And no, not all fasciculations in ALS are actually malignant, some are benign, and can occur as in healthy people- stress, etc. And oh boy, stress is one of PALS' best friends.

 

[Clearwater AL]

Igor, thank you.

Your reply is one of the better explanations of fasciculation... "twitches"
within EMGs.

As you wrote...

"You don't necessarily need to be twitching for the EMG to detect the FP. With FP deep in the muscles, EMG is most certainly able to pick them up." (FP.... fasciculation potential.)

 

[CaptRich]

Thanks for all the helpful answers. This will be my last question as it’s in regards to muscle atrophy.

I noticed while flexing my foot down I get a “dent” on the side of my calf. I’ve attached a picture with my foot relaxed (normal) and with my foot flexing down (dent). My left calf “dents” a little bit but it’s way more noticeable on my right calf.

Is it normal for this type of “dent” to occur when flexing my foot down or is it a sign of atrophy?

Thanks

 

[KimT]

You do not have ALS. Your EMG is totally clear. The dent appeared when you moved your muscle. That's not atrophy.