Should I get a repeat EMG / second opinion?

Tree123

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I previously made a thread in July 2023 when I started having twitches in June 2023: Concerned for MND

I am a 30M twitching since last summer. I have had an EMG of my right side in September 2023 and an EMG of my left side in October of 2023. They both came back clear.

Since then my twitching has intensified in frequency and now my right hand has consistent twitching, enough to keep me up and have me worried at night. It is not a twitch that I can see, but I feel it and it almost feels like an intense vibration. I have seen my PCP, doctor, and PT within the last month and all have said I still do not have any clinical weakness, but could maybe benefit from some physical therapy and treating my sleep apnea which I have a CPAP machine for but do currently not use. I am also starting to feel some perceived weakness in my right arm.

I would like to get some opinions on the following:
1) Is it unreasonable to get a second opinion and get another EMG done? The twitching in my right hand feels quite intense at times and is hard to ignore. My PCP says that another EMG is not needed at this point due to a lack of clinical weakness or any major changes in reflexes, but the twitching intensifying has me very worried.
2) In my first EMG that happened in late 2021 (for another issue) the following was said: "This is an essentially normal study. There were scattered fasciculation potentials in the left tibialis anterior without denervation. This is of doubtful clinical significance in an otherwise normal study."
I've read that fasciculation potentials on an EMG are different from twitches that we can see, and can also be said to be a hallmark sign of ALS on EMGs. Is having FPs a sure sign that I will eventually develop ALS (if i don't already have it)? I've seen some medical literature that suggests FPs on an EMG can be an early sign of ALS prior to clinical weakness developing.
3) Is it possible that my EMGs in Sep/Oct 2023 were done too early? I had started twitching in June 2023.

I appreciate any advice that can be provided. Thank you for reading.
 
1 I agree with your gp but if you must get a second opinion let them decide if you need an emg
2 there are different kinds of fasciculation potentials. The ones that are worrisome look different. From the interpretation it seems yours were the benign kind
3 no. And the fact that you have twitched without clinical weakness for almost a year should be extremely reassuring. ALS teitches are the distress call of dying motor neurons. If they had been dying since June you would have weakness
 
Thank you Nikki for your response. I felt reassured after your response, but over the weekend I developed a constant twitch in my right leg that has since not gone away. I've scheduled an appointment with another neurologist to get a second opinion next Friday.

I had been reassured and felt I was making progress, but I now back to square one with this new constant twitch in my leg.
 
Sorry to be posting here again. I will be seeing a neuromuscular specialist in October. Things have been mostly stable since my last post until about Tuesday.

Without any real injury that I can recall, I've developed what sort of feels like a pulled muscle in my upper right leg / hip area. I can still walk, but it does hurt quite a bit and do things like getting up and straightening my leg can be quite painful. I had trouble sleeping last night due to my leg being very sensitive and not being able to move freely without being in pain.

My question is that can clinical weakness present itself with the feeling and pain of a pulled muscle in the upper leg / hip area? I don't recall injuring myself at all this past week. The fact that it came on rather suddenly and seems to be getting worse has me a bit worried. I'll try to see my PCP, but wanted to see if anyone has experience with clinical weakness coming on in this way. Greatly appreciate any insights one can provide.
 
Every adult I know has had something similar. I would not be concerned as regards ALS, but it is worth checking to see that you are well supported on all surfaces -- mattress, pillow, car, sofa, etc. Springs can give out, stuffing can lose its cushioning, etc.
 
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