Symptoms with a confusing EMG

[Vik95]

Hello all,

I hope that there is somebody on this forum who does EMG interpretations or who can share their opinion on my symptoms as the last two months have been very distressing and anxiety inducing so any reply would be greatly appreciated.

PERSONAL DETAILS:

Male, 29y, obese (295 lbs/134 kg) , sedentary lifestyle, bad posture.

SYMPTOMS:

Since February 7th of this year I started experiencing strange symptoms which started with involuntary single jerks of the right arm. These jerks were followed a day or two after by fasciculations in both legs (mostly in feet and calves) which over the course of couple of days moved to other parts of the body - biceps, fingers, back, abdomen, glutes and very rarely in the neck area. To this day the fasciculations have gotten noticeably more frequent and sometimes quite strong, while other times they are less intense and not visible, but still felt. They are by far most frequent in my right leg and on the right side of the body in general, but still regularly appear in other parts as well. I'd say they are intermittent, they are not constant (like 24/7) but I do go to bed with them and wake up with them.
Over the last two weeks, when I walk, I started feeling strange stiffness in my right leg, mostly around the calves, like someone is griping parts of my leg. I also noticed that when doing repetitive movements (moving the foot from left o right, taping the floor with my toes etc.) the right leg/foot is noticeably slower and seemingly weaker. It is harder to lift my right foot than my left. The right foot is also less flexible.

Additionally, for last three years I have occasional cramping, mostly in my feet and calves, I can often induce them by stretching or clenching my feet, but in the last two years started occasionally having cramps in my abdomen as well. Haven't noticed increased cramping in the last two months.

FIRST NEURO EXAM:

On February 13th, very quickly after symptom onset, I went to a neurologist who specializes in motor neuron diseases and is considered to be the best ALS specialist in the country (Serbia ). After her exam she noticed a slight tremor in my right hand, a slightly reduced ability to feel vibrations on my right side and increased reflexes of the masseter. She didn't notice anything else and said that there is no need to do an EMG. She asked me to do an MRI of the head, blood works, SEP and MEP tests. Her conclusion was that my jerks and fasciculations were likely due to anxiety and prescribed me Xanax. I was told to come back when all the tests were completed.
To note, the neurologist didn't test repetitive movements of my legs/feet, only hands.

AFTER THE EXAM:

Xanax seems to reduce involuntary jerky movements (not 100% sure), however the fasciculations have not been reduced at all, quite the contrary.
Blood works were normal, apart from hypothyroidism (TSH - 7.78 mU/L)
SEP, MEP and MRI were normal.

EMG TEST WITH RESULTS:

Because of persisting and worsening symptoms as well as increased health anxiety I decided to do an EMG test on March 18th at a different clinic and the results are posted below. The summary of the EMG roughly translates: "Noticed chronic neurologic (neurogenic?) lesions in S1 and S2 muscles on both sides, the left calf exhibits spontaneous high frequency discharges. The results imply peripheral nerve hyperexcitability. Other results are normal. In general the EMG is clean. No indication of NMD." What the doctor performing the EMG told me is that there are signs of reduced motor units in my legs, however she said that she doesn't think that this is caused by a NMD but that it can't be completely ruled out.
Reduced motor units in combination with peripheral nerve hyperexcitability (fasciculations and occasional cramps) are what is worrying me the most as these symptoms are recognized to sometimes be the beginning of ALS, months (sometime years) before other symptoms can be noticed.

I am to return to my ALS-specialized neurologist by the end of April (no sooner appointment ) when she is supposed to interpret the EMG results.

Regardless of my upcoming control examination with my neurologist I am inclined to do another EMG test in a couple of months that is much more thorough as the EMG doctor tested only in 5 muscles (three in right leg, one in left leg and one in right arm I believe).

 

[KimT]

It doesn't look like a typical EMG of someone who has ALS. The lack of spontaneous activity (positive sharp waves and fibrillations) is absent in all muscles tested. It isn't unusual to only test five muscles in an EMG.

There is a condition called cramp fasciculation syndrome that might be considered.

Also, because you admit to both anxiety and obesity, these two issues can cause all sorts of health issues. I'd focus on eating healthy, drinking plenty of water, giving up caffeine and processed food while you wait for your next appointment.

I hope you are getting restful sleep. If not you might consider a sleep study.

Best wishes. Let us know what you find out in your appointment in April

 

[Vik95]

Thank you Kim for your response, I will definitely update this thread after my future appointments and in the case of developing dramatic new symptoms (clinical weakness, dropped foot etc.) in case somebody stumbles here in the future.

All the best!

 

[Vik95]

UPDATE IN CASE SOMEONE STUMBLES IN THIS THREAD IN THE FUTURE:

Somebody else cancelled so I was able to see my neurologist earlier, on March 26th.

She looked at the EMG results and said that it indicates that my problem originates from the spine and that I am most likely dealing with radiculopathy. Considering that I am overweight and that I have frequent but not severe back pain, this seems the most likely cause for my issues as well. She dismisses the possibility that I have ALS and that I am, on the whole, "fine", which did put my mind at ease for the most part, at least when ALS is concerned. Since then it seems that my fasciculations have become less common so I am more accepting of her statement that they were, if not caused, then exacerbated by my anxiety (although for 6 moths before they even started in February I didn't have any problems with anxiety or stress). I still have no explanation for the involuntary jerky movements, but they also seem to be less common in the last few weeks.
She said that I need to do an MRI of my spine and then report back in a few months.

I still have tightness in my right calf muscles when I walk, my right limbs tire more quickly, are less flexible and dexterous than my left limbs and I have pain/tightness in my right shoulder. I will be seeing another neurologist (he specializes in Parkinson's disease but has experience with ALS patients as well) sometime in May. By then I will also do an MRI of my whole spine and report back to my first neuro.

If this thread doesn't get locked I plan to update it by the end of May or if something else comes up.

 

[lgelb]

Thanks for checking back in. If the thread is locked, you can open another and link to this one.

Often, it's not anxiety that first causes these niggles, but it's anxiety that gives them more importance than they deserve, which only makes them feel worse.

When one side is stiff/painful, it's also wise, expecially when carrying too much weight, to look closely at your sleeping position (you can use video), and whether your pillow/mattress/overlay are really doing their job. And if you are eating/drinking/smoking close to bedtime, all those can make your sleep more restless, further compromising whatever spine issues you have. You can track your stages of sleep with a wearable and see where you stand for your age/gender.