Progressive weakness, EMG with fibrillations

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youngf

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Hello all,
thank you for the opportunity to post here.

I am 35yo male. It started with noticing that fingers "wouldn't listen" when typing on the computer, March/April 2021. At the same time, widespread fasciculations, shortly after shortness of breath at night, and now weakness in right leg for about a month, getting more and more noticeable, I am starting to limp. I decided to visit a doctor in May, and got referred to a neurologist straight away. I had blood work done, the results showed nothing significant except elevated herpes zoster antibodies. I was seen by 2 neurologist in May, one did a clinical exam, the other did EMG (3 limbs). The EMG report mentions fibrillation potentials, "characteristically sounding" MUPs, mostly in the left deltoit. The fibrillations disappeared when the needle was moved, and it was noted that there were also normal MUPs. The nerve conduction exam was normal. The conclusion of the EMG report mentions "unspecific findings", suspects myogenic lession, and recommends to repeat EMG in 3 months. The neurologist also sent me for further blood work, thyroid, minerals, etc. which all came negative.
I am also noticing "spasms" or kind of shocks where part of my body jerks, be it shoulder, leg, back, and also chin. I sometimes wake up and am unable to move my chin at first, but can move it after a short while. A few nights ago, I felt like it got more difficult to breath, the chest became "heavier". Every day seems like my legs get weaker sooner - it used to be that I felt weak in the afternoon, now basically whole day.

The neurologists who performed EMG also asked about troubles swallowing, chewing during EMG - I reported no problems with that at that time, and is still fine. The other neurologist gave me a diagnoses of tetanus, which I don't buy, since tetanus is not supposed to be progressive and constant, right?

I have to say I am quite stressed because from what I read so far, the arrows point in an ugly direction. I am blessed with 3 small kids under 5, who give me so much joy and love. So far I haven't really stumbled or fell or dropped anything unexpectedly, but I feel like I have to be careful, as it feels like my legs are made of straw. Could this be all happening so fast? I hear people saying things progress over months or years, and here I am, getting significantly weaker in a course of maybe 4-5 weeks.

Btw. I am going to see another neurologist on Tuesday, to get another opinion and to hear what they think about the EMG findings.

Sorry for the long post.
 

affected

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Let us know what the new neurologist says, but I'm trying to figure out what you think is wrong?

Let me say why by quoting you:
The conclusion of the EMG report mentions "unspecific findings", suspects myogenic lesion...
neurologist gave me a diagnoses of tetanus...

Please read here really carefully as it should help you a lot:

So far you aren't reporting the hallmark symptoms of ALS, but there is of course something going on.
You will have some more answers next week, so pop back and update us then.
Start living and putting all your energy into your kids in the next few days - they grow up so fast, don't waste this time. Regardless of the diagnosis you end up with, you won't have your time with them back.
 

lgelb

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If you really have tetanus, you would need a tetanus antitoxin injection right away. So if you have not been vaccinated, if you suffered an open wound, and if your symptoms are progressing, I would pursue that first thing in hospital.

"Myogenic" findings would mean a problem that originates in the muscles. ALS originates from the motor neurons (nerve cells). So if you have something in that realm, it's pretty certain that it's less severe than, more treatable than, and not ALS.
 

ShiftKicker

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Laurie, I am thinking it's the formal description of the muscle activity (for the curious, def: the prolonged contraction of a muscle caused by rapidly repeated stimuli.) and not naming the disease.

OP, I am hoping you get more answers from your next appointment shortly. It might help to have your questions written down ahead of time to make sure you get them all answered.
 
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lgelb

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That would be tetany. Yes, I thought about that, but erred on the side of caution.

Regardless, "myogenic" dysfunction would rule out ALS, as that means originating in the muscles. If herpes zoster is a possibility, that should certainly be explored as well. It's also possible to have two things at once. But neither is ALS.
 

youngf

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Thank you for your replies and encouragement.

The conclusion of the EMG report mentions "unspecific findings", suspects myogenic lesion...
neurologist gave me a diagnoses of tetanus...

Please read here really carefully as it should help you a lot:
I have read that post carefully before posting, and I wouldn't have had posted if at least the EMG was clean. I'm sorry for providing incomplete information, the EMG report says "possible myogenic lesion, but there was no characteristic myogenic or myositic pattern".

Laurie, I am thinking it's the formal description of the muscle activity (for the curious, def: the prolonged contraction of a muscle caused by rapidly repeated stimuli.) and not naming the disease.

OP, I am hoping you get more answers from your next appointment shortly. It might help to have your questions written down ahead of time to make sure you get them all answered.
Thank you, will do!

That would be tetany. Yes, I thought about that, but erred on the side of caution.

Regardless, "myogenic" dysfunction would rule out ALS, as that means originating in the muscles. If herpes zoster is a possibility, that should certainly be explored as well. It's also possible to have two things at once. But neither is ALS.

I incorrectly translated the diagnoses, it was supposed to be tetany as you and ShiftKicker correctly deduced.
 

affected

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The EMG does not seem to suggest anything that would lead to you thinking ALS.
Please let us know once you have more results after the appointment coming up.
 
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