Some feedback and assistance required with interpretation of Emg

[Barcabatch]

Hello all,

Hope you are well. I was recently referred by my neurologist for an EMG due to muscle wasting and weakness and widespread fasciculations.

I got the Emg summary over, but have a long wait till follow up. Can someone help interpret the results in the interim to help put my mind to ease while I wait for the follow-up?

What does reduced recruitment pattern, 1+ HF and MUAP sections refer to?

I have reduced recruitment pattern for 8 of the 14 tested muscles with 1+ amp, dur and PPP. In two of the muscles there is 1+ HF as well and there were fasciculations noted In a few of the muscles also. The insertion activity, fibrillation and POSITIVE sharp wave results were normal/none.

Attaching the emg image for reference.

Does it look more like spinal issue that I should discuss with physio?

Any feedback is appreciated. Thank you.

 

[lgelb]

It's not a typical ALS EMG; there's minimal evidence of acute denervation and it's missing some things that would help understand it, like motor unit size and how much recruitment is reduced. HF=high frequency

Importantly, the fascics that you report experiencing would never be the same as those seen on an EMG.

I wouldn't worry about ALS at this stage. Without knowing your medical history and what your neurological examination showed, there is no way to speculate as to what is wrong, but I would imagine that if the neurologist felt there were important news for you to have, you would hear about it before December.

Still, I would reach out to the office and express your concern about the wait, and fish for information that really should be available to you under the circumstances. And I would ask to be put on a cancellation list so you could see them sooner if an opening comes up.

Best,
Laurie

 

[Barcabatch]

Thanks for the response. I had a brain, cervical spine and lumbar mri already which didn't show any nerve pinching which was initially the assumption of the office. I have gone through every other testing possible for now including the emg and nerve conduction, the nerve conduction test prior to emg was normal.

My most recent neurological strength test went alright, I was able perform the activities requested by the neurologist including walking on heels and toes, squat position, raising my legs and feet while lying down, did hand grasps, did upper extremity strength and did lower body strength. Some brisk reflexes were observed but office said that it can be possible because of stress and anxiety as well in a lot of cases.

Some muscle loss and weight loss was noted, however, stomach issues and lack of activity in recent weeks may have also contributed to it.

I do have weakness in body, specially in my dominant arm and leg, but that isn't clinical as I cleared the strength test.

I am just stuck in a limbo now without any clarity on the exact cause of the issue and somewhat Abnormal the emg result. I just don't know what else can be causing this, aside from this, my health in the past was relatively good except for mild stomach issues on and off.

 

[lgelb]

I would advise you not to focus on what you don't know, and more on what you do. "Limbo" is often self-imposed. Do what you can do in life, which sounds like a lot in your case.

Brisk reflexes are not in themselves anything dangerous. And "nerve pinching" doesn't always show up on imaging. A physio consultation might be of use to see what exercise could help.

Strength is much, much more important than what you look like. And as you say, there are logical reasons behind weight loss, feelings of weakness, and muscle loss that are reversible. So I would certainly make sure you have the best help available for your stomach issues, even if it means consulting with another physician or dietician, because nutrition and absorption affect everything else.

 

[Clearwater AL]

Maybe I'm missing something here... an EMG report has a Summary/Conclusion at
the bottom of the report. Maybe you could copy and post that... his/her comments,
determinations.

 

[Barcabatch]

Thanks. They are supposed to provide that and more in follow up consultation to discuss the results. After some pushing, I was briefly told that it was suspected radiculopathy, but the MRI results for neck and spine don't correlated with that as both did not show any evidence of pinched nerves and the physio also didn't see any clear links to radiculopathy.

Thank you

 

[lgelb]

Were nutritional deficiencies, blood disorders, infection, post-viral syndromes, etc. ruled out by your PCP/labs?

 

[Barcabatch]

Thank you for the response. Yes, all necessary bloodwork was done to rule out infections or virus and I also went through rheumatologist for all autoimmune labs which came out fine, thus the referral to neurologist. So far, aside from the Abnormal Emg, I have passed the normal neurological strength tests so far and only came up with hyper reflexes and Fasciculations which I'm taking as a positive sign. I do have weakness but as mentioned above, it's not really clinical as I'm still able to pass the strength tests.

For my L5-S1, the MRI only showed minor disc desiccation with no neurological issues such as pinched nerves and cervical mri only showed one or two tiny osteophytes with no clear pinched nerves. The emg however picked problems in both areas, I have heard that sometimes mri doesn't match with emg and imaging may not always show radiculopathy. I do not have any neck or back pain, but do have bad posture and loss of lordosis in both areas, so maybe that added up over years resulting in some irritation of nerves.

For now, I will focus on Physiotherapy and will wait for the expert/neurologist opinions, it may be a long wait, but hoping to be in a better position by that time. I'm hoping that it is either radiculopathy or some post viral syndrome that will improve over the coming months as I've had quite a tough year due to these concerns.

 

[Barcabatch]

Just an update on the neurologist followup, I have been told that it is mild chronic l5, s1 radiculopathy along with mild chronic cervical radiculopathy.

The cervical and Lumbar spine MRI have come out clean though with no signs of pinching and the physio didn't see any signs of pinched nerve in lumbar or cervical spine throughout the initial sessions. I also don't have any pain in neck, back or legs.

The weakness is still there and I'm also suffering from nystagmus on and off along with body wide Fasciculations, hypereflexes, stomach issues and muscle loss. However, the weakness is not clinical and I'm still able to perform most of the routine tasks with some more effort. I am suffering quite a bit overall and the current situation has greatly affected my personal, professional and family life, but trying to stay positive and hoping that things will take a turn towards better now.

Hoping that it is indeed some light radiculopathy that weans off over time through exercise and PT and I'm able to build back the lost muscle, heal the nerves and return back to routine.

I see no use in challenging the judgement of the doctor as they know better than me or Google, thus I'll try to push through a month of PT to see how it goes. Hopefully I'll be back with some positive news by the end of the month.