Still Looking for Answers

[Pamela Monzingo]

I had another post in this forum and it was closed, so I can't post to it any longer. (past thread: Confused About EMG)

It has been three years since all of this has started. I have switched Neurologist, since I was unable to get any type of answer from my first one. He did two brain MRI's and NCS/EMGs and was only able to state that I had peripheral neuropathy and diagnosed me with carpal tunnel syndrome. He was very dismissive and said to come back to see him if anything changed. I went back to him at the beginning of this year telling him that I had noticed atrophy on the whole left side of my body both upper and lower, most notable in my foot and hand. He did strength tests and since I passed he said it is peripheral neuropathy and left it at that. I went to a new neurologist and again I noted all my symptoms and concerns, he did a NCS/EMG and I am attaching those results - he only did my lower body (not sure since I told him it was my whole left side). He did the new study because he was confused by the findings of the last doctor. He also did a strength test both upper and lower body and I passed. I did notice on the EMG in the Poly section that in both my left and right gastroc and Anterior Tibialis that it states "pres" while all other muscles tested are "nml". I am waiting to get my blood tests back and he has referred me to a rheumatologist.

Can you please help me to understand what the "pres" on the EMG means or if I need to seek another neurologist to find answers.

 

[lgelb]

Not sure why "only" peripheral neuropathy and mild CTS was a problem. Everyone here would take that!

The EMG shows polyphasic motor units in your tib/fib motor neurons (lower legs) but not any acute denervation (nothing on the left side of the table), suggesting chronic damage of some kind but not a progressive disease like ALS or anything similar. Your strength not having changed significantly speaks to the same confidence. And as you will have read, perceived atrophy ≠ clinical atrophy.

The NCS shows a sensory neuron deficit in your legs.

So you put these together and you get "sensorimotor neuropathy." It's pretty common and can relate to diabetes, thyroid, and other endocrine abnormalities, past injury, systemic conditions, or just the luck of the draw. It's certainly a good time to look at your leg position in sleep, work, and play -- is your bed supportive, etc. And wearing shoes/socks designed for PN can be helpful.

Without knowing all your past tests and exam results, I can imagine a rationale for the rheumatology referral and blood work. Depending on the results, you may be referred for PT.

Anyway, time to put ALS to bed and focus on what's in front of you.

Best,
Laurie

 

[Pamela Monzingo]

I am very sorry if I offended anyone, that was not my intention.

Thank you for your feedback.