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dott

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Good morning,

I'm new to this forum as a member, but have reading you for a while and know enough to be really scared. I am female of 32 years old, with neuro symptoms for two and a half years. Since than I have been to two neuromuscular neurologist several times.

Prior these symptoms ( 9 years ago) I had very short therapy with accutane for acne (which is also chemoteraphy drug but is used in much smaller dosage when prescribed for acne) and now have problems with very slow skin healing, even a minor cut leaves nasty scar. Also since than, I have intermittent pain in hips and knees.

So, for two and a half y. I have complained for non-stop twitches (which never stop), which are appearing all over (even on my nose, tongue, back, belly) but neurologist never saw one on the exam and some changes in muscle bulk that started in the beginning and are very slowly progressing- thenar eminence, first dorsal int., brachioradialis, gastrocnemious and ext. digitorum brevis. It is all in my left body side. Also have problems with tongue feeling weird and sometimes feel fasciculations on it.Both neurologist said that there is nothing abnormal in these muscles I showed them. (But I am fairly certain that there is change in them since I'm quite an observer)

In the beginning on the neurological exam i presented with normal reflexes or normal on upper body and quite brisk in knee jerk, but no clonus. I have no plantar response (than and now still).

Yesterday I have been on another neuro exam and neuro wrote that I have quite brisk deep tendon reflex everywhere.

Neurologists never found any clinical weakness but I have percieved weakness that I feel when I play piano, or when I try to extend my toes.
It is harder for me to touch tip of my little finger with the tip of my thumb, whilist on my nondominant side there is no problem with doing that.

3 emgs were perfomed in the beggining, and yesterday.
Almost all muscles that i feel problems with have some chronic denervation from the beginning of testing 2.5 y ago ( high amplitude - up to 6 mV). Yesterday thenar muscle showed some insertional activity but it was in normal limits. From the begining neither neurologist found no fasciculations, PSW or fibrilations in any muscle tested.

All NCS studies were completly normal.
So it leaves me nowhere. I am concerned that I have chronic damage in those muscles, but there is no explanation for that. Am I right that it could not be any kind of neuropathy since there is no problems with NCS?
I know that some of my muscles are smaller in size although neurologists never think it is the case.

Few months ago I developed eye floaters in left eye, but I don't have it always. Also, this whole month I have excessive yawning for like 20-30 times in a day.


Please give me some ideas what could be the cause for chronic denervation, minor and slowly progressive atrophy and brisk tendon reflexes. Prior to neurologic symptoms I visited a rheumatologist and had blood tests for autoimmune conditions becouse of skin problems and joint pain but it was all clear. Also my mineral status till today is normal.

Please advise me!
 

dott

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P.S. I’m really not imagening my atrophy, I found my photos from vacations years ago and my left thenar muscle is much bigger as is my left gastrocnemius. I don’t know why the neurologists says they can’t see any atrophy. Maybe because they didn’t see me before. It would certanly point to severity of my atrophy as it is not great, but it is enough to concern me. My thenar muscle has 3-4 mV amplitude. And is silent at rest.
 

Atsugi

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Dott,

I recently visited Budapest. Wonderful, beautiful. I hope to return. Budapest has the most beautiful women in the whole world.

Your post said nothing that might seem like ALS.

The things you wrote gave me the impression that you are experiencing the normal wear and tear of your body as you get older.
 

dott

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Yes, that is also my humble opinion of our city, but I am subjective :)

Thank you for your your reply. If someone here have some knowledge about EMGs like (i think his nickname is Wright), It would be very helpful to know the possibilities of my readings of high MUAPS in some muscles.
I was reading some old posts here where he replied to some members regarding EMGs with chronic denervation and nothing else, that it could be of no significants and or there could be something but no ALS. I’m trying to understand those findings. And since im having really brisk reflexes (+3), of course I’m a bit worried.
 

Atsugi

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If you post the EMG findings, someone will come along to read it. Wright is no longer here.

Brisk reflexes are common in healthy people, and chronic denervation happens over time. The important thing in ALS is weakness in a single muscle (like a hand) that has no cause and never improves.
 

dott

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I tried to translate the summary, and will try to post a photo of findings in table.

“Concerning the suspicion of amyotrophic lateral sclerosis (ALS), in the last two or three years, several electro-trauma investigations have been performed. Translation in motor and sensory peripheral nerve axons was always normal. Pathological spontaneous activities (positive sharp waves, fibrillation potentials and fissile potentials) were not found. In opinion polls, some people mention signs of chronic obstruction of C5 to C7 nerve roots, while others show signs of chronic nerve root defect L5.
There are no clinical signs of ALS.
Due to the normal, proven results of peripheral nerve translation, these investigations are not repeated today. The needle electromyography is performed only in the muscles in which they were found at the previous examinations. described signs of chronic denervation.
In none of the examined muscles there are no positive sharp waves and fibrillation potentials as well as no potential for fasciculation. Potentials of motor units are normal. Some of the larger potentials of motor units only find the short finger extensor in the muscles, which is normal for this muscle.”
 
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dott

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This is my medical report

Mrs. **** was examined because of her fear of having motor neurone disease (MND). For the last 2 years and a half she experiencing muscle twitches in all body muscles. They are more numerous while being tired or nervous. They may awake her from sleep. After she discovered that that such muscle twitches (fasciculations) might be a sign of MND she became extremely anxious and worried. She has heard from several neurologists that she is not having this disease but is still not convinced. The lady is also reporting on muscle cramps affecting mainly the feet but rarely also calf muscles. There is no definite history of the limb muscle atrophy or weakness, no problems with speech or swallowing, no complaints of dyspnoea. Also the symptoms do not progress over years. There are other minor complaints that bother her: e.g. slight indentation in her left distal forearm (my feeling is this represent a normal space between two muscle tendons) that is sometimes painful, atrophy of the left thenar eminence (which I do not see), difficulties in extending her left toes (normal muscle strength of toe extension on today’s examination), some sort of tiredness while playing piano, pain in the left scapular region.
The results of all laboratory examinations obtained by now are normal. EMG examinations were performed on several occasions. Some reports describe mild abnormalities compatible with bilateral C5 to C7 or bilateral L5 nerve root lesions (despite of the fact that the patient is not complaining of neck or back pain irradiating to the limbs and being associated with numbness and/or muscle weakness).

Her tongue is not atrophic and there is no fasciculations in it. Its movements are quick. There is no facial muscle weakness, no signs of pseudobulbar affect or of the pseudobulbar involvement.
Muscles of the limbs and trunk are not atrophic or weak. No fasciculations were noted during the examination. Muscle tone is normal. Tendon jerks are quite brisk with plantar responses in flexion.
 

KarenNWendyn

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EMG sounds good to me. Your translation states no signs of ALS. Also no sharp waves, complex repetitive discharges or fibrillations. That’s all good for clearing you of ALS.
 

dott

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Dont know how to post a pic, here are my results:

L APB muscle: fib. potencial: 0, spontaneous activity 0, amplitude: 4mV, duration: N, poliphasicity: N, recruitment: N

L GASTROC. CAPUT MEDIALE muscle: fib. potencial: 0, spontaneous activity 0, amplitude: 3 mV, duration: N, poliphasicity: N, recruitment: N

L EXTENSOR DIG. BREVIS muscle: fib. potencial: 0, spontaneous activity 0, amplitude: 7mV , duration: N, poliphasicity: N, recruitment: N

R EXTENSOR DIG. BREVIS muscle: fib. potencial: 0, spontaneous activity 0, amplitude: 6mV, duration: N, poliphasicity: N, recruitment: N

Conduction velocity NORMAL.
 

Nikki J

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My reading of post number 6 is that on this latest EMG they did not even see the chronic denervation. Despite its name these chronic changes can come and go and may be normal. They could represent an old injury and they can also be seen in extra strong muscles.

As Mike already told you brisk reflexes are found sometimes in healthy people and also in anxious people.

You had a normal exam. You have apparently seen several neurologists over several years. They all told you the same thing. Please consider that continuing to follow this road can not be healthy. It is time to seek another path. Talk to your regular doctor about this

ETA your follow up post confirms a normal EMG
 
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dott

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Thank you Karen! I didn’t see your reply untill now-i’ve been preocupied translating findings in table (my bad).
I hope that someday I will find the answer to my problems that I’m faceing. I will inform you of my findings.

Sorry for taking anyones time! And thank you very much for answering.
 

dott

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Thank you NikkiJ!
I appreciate your time regarding reading my posts and answering! Thank you all very ver much ❤
 

Atsugi

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What am I, chopped liver?

:)
Just kidding.
 

Livealot

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No Dott , the doctor's are trained to observe too.This is a club no one wants to be a member.of .Please enjoy a healthy , and long life .All the best to you.
 
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