Questions about EMG/NCV

[Bill Smith]

Hello. I have some questions about an EMG/NCV. I will give a short summery of what led up to the test.

-late 40s
-Started experiencing twitching and cramps 4/22. First in the lower body, then moving to the upper body.
-The cramps and twitches were/are constant and everyday.
-This went on for months.
-Did a lot of research, including on this forum, came to the conclusion that since there was no weakness, then there is no ALS.
-Then, in about 5/23, I started having weakness in first the right hand side of my/shoulder/arm/hand. Then it moved to the left.
-There was pain involved, and so since it's a disease of motor nerves not sense nerves, I still was pretty sure I didn't have it, but nevertheless, I made a neuro appointment.
-I had an EMG/NCV in July 2023.
-The results were "No Electro-diagnostic evidence of Anterior Horn cell disorder/Motor neuron disease or myopathy noted."

I am of course happy with this result, but at the same time, there were some things which disturbed me and make me want to get a second test somewhere else. The report is full of info stating that I have all kinds of "decreased conduction velocity" and "prolonged latency" and "increased polyphasic potentials" in my motor nerves. Isn't this exactly what they are looking for in terms of what shouldn't be there? The report says "cold extremities" were the reason maybe, but this was in Florida in July and the office was hot, as if there weren't any AC almost, and I was sweating so bad that the DR. said that she was having a hard time doing the study. So my extremities were definitely NOT cold. So to be concise, I guess my questions are.

1. What exactly are they looking for in an EMG/NCV to indicate ALS if not the slowed velocity? This slowed conduction velocity seems to be EXACTLY what they are looking for.
2. Is the "slowed conduction velocity" one and the same with the infamous "denervation"?
2. Is there some other variable that they are looking for that should accompany the slow velocity that I DON'T have, and so the fact that I don't have any of the other variables is the reason for not being concerned?
3. People post a lot of EMG/NCV on this forum. Are these features such as "decreased conduction velocity" common in people who DON'T have ALS?
4. What could be another non-ALS cause for these?
5. Do you think I should get another test?

I have other labs and scans that were ordered such as brain/spine MRI if you think these would be useful.

Thank you very much.

 

[Nikki J]

All your abnormalities except the slightly increased polyphasic potentials in one muscle were nerve conduction abnormalities. Anything on the ncs points away from ALS. The slight finding on the emg isonsidered a normal variant. It does not relate to Als. Als shows acute and chronic denervation in multiple muscles on emg. You had no sign of that

You have had symptoms for almost 2 years and your emg shows no signs of ALs you need to let it go. Your doctor apparently thought the ncs findings unworrying. Peroneal nerve issues can often be seen in people who cross their legs or sit crosslegged but they didn’t think your ncs was remarkable enough to make any suggestion.

Go to your pcpif you feel you have symptoms that need treatment but you are in the wrong place here

 

[Bill Smith]

Thanks for the reply. I really wasn't looking forward to another go round of the needle and shock tests anyways. I am seeing a second neuro Dr. that I had already booked long ago and I will show them the data and see what they say as well, but your opinion and insight are very helpful in relieving the worries I would have in the mean time. I won't post again.