Should i get a new EMG for Bulbar?

[Allyatorio]

Two years ago i had a emg done in four limbs after a heaviness in left leg, shoulder and arm, also left side fasciculations, came clean (fasciculations never stoped and spread to the rest of the body and almost one full year with scapular pain, and poor balance to this day).
Seven months after the emg i felt a paresthesia in my left cheek, looking into de mirror it had a small dent, but at that time i was trying to convince myself that it was all anxiety. One year and six months later, december/2022 a sequence of symptons began:

Back paresthesia like something glued to it, a inexplicable itch all over the body, left hand little finger extending by himself (wartenberg?) and paresthesia, Neck and face paresthesia, and then it focused on the left cheek, 24/7, and so i noticed that it was now flat while the other cheek was round, days passed and it reached the corner of my mouth, when i talk it gets wet, um month after the other side started getting wet too, days after, my voice pitch changed for something higher, strident, as a "amateur" singer i got really scared after noticing almost a octave higher vocal range, that if used would get me hoarse for days. For the first time i had twitching in my tongue, left side, and now everyday i feel a tightiness in my face. I started bitting my tongue while talking and sometimes the lips. (used to bite inside of cheeks months ago but blamed it on my braces, months ago also had pain on my tmj, now it clicks. Also the last two weeks i've feeling like going to the bathroom at random times, but nothing comes out.

I have bilateral hoffmans, bilateral patellar hyperreflexia, used to have bilateral negative babinski, but now it became mute in my left foot (this scares me).

Does it sounds like a possible Bulbar? Should i get a head emg for precaution? I don't have insurance, so a premature diagnosis would give me a chance to get one (especific for this disease) and pay for decent care.

In advance I want to thank everyone who helped me and apologize for the inconvenience of my questions.

 

[ShiftKicker]

Hi there-

Sorry you find yourself back here almost 2 years after your last visit. You still report sensory issues, primarily- which is not at all how ALS starts. It's not really clear what is going on, but after 2 years of worries about ALS, this is still not how ALS begins. You will have to work with a doctor to help figure things out.

Please take care

 

[lgelb]

At least part of this is still, and prominently, anxiety.

I would not waste money on another EMG, especially if it would be aimed at an ALS diagnosis. If a neurologist really thought you needed one, you would know that.

Ongoing paresthesia would seriously affect function more than you report. The most plausible explanation for what you describe boils down to lack of sleep. It is hard to get refreshing sleep when you are stressed. It might be worthwhile to keep a sleep/diet/exercise/stress diary and work on the things that make you function better. Looking closely at your chairs, sofas, bed, etc. may also be worthwhile because positioning can very much affect things like shoulder pain, and keeping your mouth open in sleep, especially in winter, can certainly affect your voice and saliva.

I am presuming the braces relate to TMJ, so why would it be surprising that they have helped the pain? And TMJ dysfunction does cause clicks. Many people, especially with jaw problems, bite their cheeks and/or tongue from time to time.

In short, I would find a good GP and counselor who can help you develop a plan for feeling better and stay with the plan. I see no reason for worrying about ALS.

Best,
Laurie

 

[affected]

Do you have a diagnosis at all?
What does your doctor think is going on?

Really doesn't sound like any ALS onset I've ever seen which is great news.