Normal EMG? Symptoms progressing...

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lmblmb

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Thank you to all of the courageous and caring people on this forum. I've been fund rasing for the past 15 years and will continue to do so. I seek your guidance on the history below and EMG images - Thanks again

History


60 years old
20 years of intense athletics: including resistance training, HITT, and cardio (some would say too intense)
Prior to 2017 - years of leg muscle cramps and forearm stiffness (particularly at the inside joint of the elbow)
2017 - ran half marathon - ended up in the medical tent for over 2 hours with muscle cramps in legs, abs, neck, and arms
2019 - July continued relatively intense physical activity including long hikes and ice climbing, noticed some reduction in strength of shoulders and neck
2019 - August - road Pan Mass Challenge - at 70 miles, severe muscle cramps in both legs - ended up in medical tent for 30 minutes attempting to roll out lag spasms
Saw PCP because of severity of legs cramps and perceived muscle weakness in right leg
11/2019 - First EMG - right leg and arm only - normal (screen shots below)
2020 - through March - continued to workout at high level and continued to feel weakness in right quad with burning along outside of thigh and left foot lack of sensation under big toe and foot pad
2020 - March through October reduced 5 day a week training to 2 days and continued to have weakness in right quad, left foot lacking sensation is worse, extended to all toes
2020 - August - neurologist appointment - normal exam, despite complaints of right leg weakness, leg foot numbness, and left shoulder atrophy, constant stomach fullness at night. Frequent awakenings during sleep;
2020 - October - laminectomy L2-L3
2020 - Since then, when walking, feels like I can’t feel right leg - and there is a lack of muscle endurance - lack of muscle endurance in left foot - notice atrophy of left foot
2020 - December - normal neuro exam; 2nd EMG - images below
Symptoms progressing: atrophy of both hands, both feet, and shoulder muscles, stiffness in forearms, triceps, and biceps, ankles, neck extensors, and flexors, cramping in both hands, and feet, frequent awakenings during sleep, burning along tricep, electric shock like on inside of right shin odd, muscle twitching legs, abs, shoulders, and glutes
grip strength seems reduced; left shoulder buzzes or feels like someone is pressing on the outside top of shoulder
Exercise leaves muscles very sore and fatigued beyond the normal expectations after exercise
Overall strength is good - endurance is off
Questions
  1. Is this considered a clean or dirty EMG - what does +1 and reduced values mean in a few of the columns
  2. Looks like a slight change from first EMG to second realtive to right leg.. is it remarkable?
  3. How could EMG on APB be normal and now 30 days later there is atrophy
  4. Isn’t reduction in muscle endurance or muscle fatigue a precursor to clinical weakness
  5. Does muscle fatigue show up on EMG
    Screen Shot 2021-01-22 at 5.59.26 PM.png
    Screen Shot 2021-01-22 at 5.59.00 PM.png
    IMG_0963.jpeg
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  6. The real bottom line question is are all of these symptoms pre clinical signs that at some point convert to the requirements of an ALS diagnosis
 

Nikki J

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Hi
there is nothing on the emg to indicate ALS. The things you note are not remarkable and no I wouldn’t call it dirty ( though that is a non technical term)
if there is clinically confirmed atrophy and a normal emg then the most reasonable explanation is something else is causing it - not MND
muscle fatigue does not show up on emg neither is it a common presenting sign of ALS failure is the hallmark of ALS which presents to the doctor as clinical weakness
your history does not sound like that of a PALS

if you have not already done so make an appointment to see an intown neurologist to rule out a neuro cause since that is your concern. Mgh is the best. I do not think you should try for the ALS clinic as you need a less focused evaluation yo find out what is the problem
 

lmblmb

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Nikki, Thank you for your interpretation of my symptoms and EMGs. I do have an appointment scheduled with an MGH neurologist focused on neuromuscular disorders. Given the progressive and widespread nature of my symptoms, along with many of the stories I've read, of course my mind still races towards some systemic problem. For now, I'll try to park any more concerns and wait for my next neuro appointment. Thanks again, LMB
 

Nikki J

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If you are going to mgh they will figure it out. I am not saying you are fine just that it seems like something else from what you have so far said. Do not be surprised or alarmed if they repeat the emg. Unless they know the original emger they often want their own

let us know what happens. Good luck
 
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