Update...still worried

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juleva81

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Good afternoon everyone. I am writing again to update my situation in case it can help someone and to humbly ask for your opinion. My previous thread is already closed but I put the link here so as not to repeat the whole story.


The news is that I have visited another neuromuscular specialist, and the EMG says two things that worry me a lot. On the one hand, there is motor conduction block in the left ulnar nerve and median trapping of the right hand. Also fasciculations in the left arm. And what worries me the most: chronic denervation with increased pum in the right anterior tibialis. I remember that I had a back operation in 2015 and, according to the doctor, this chronic denervation may be a consequence of the operation. But in that same leg I have a lot of fasciculations. I'm worried that this is the start of ALS because a year ago my emg was totally clean and now it has all those things. I am also concerned that an EMG in 2017 after the operation already showed the chronic denervation, but then last year's EMGs were normal, and now the latter shows the chronic denervation again.

Can a chronic denervation with increased pum appear and disappear from the emg? Can motor conduction problems be a sign of MND?

This concern is horrible. Thank you very much for your opinion in advance and I send you my best wishes.
 

lgelb

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Yes, depending on the operator and equipment especially, but more importantly, a diagnosis of ALS requires both acute and chronic denervation.
No. Physiotherapy, exercise at home, and more interventional procedures if needed, are all options for therapy. ALS is not associated with conduction block.
I would follow up with a physio about reducing the pain from the nerve problems in your R hand and leg, but the findings you report don't align with ALS.

Best,
Laurie
 

juleva81

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Thank you very much for answering so quickly. My main concern is the EMG of the leg, because there I also have many fasciculations. I have read that by Awaji's criteria, in an area with chronic denervation, fasciculations can be considered acute denervation. Do you know if this is so? Because in that case there would be acute and chronic at the same time. How awful. this concern is inhuman. No one should go this long way to confirm or rule out such a terrible diagnosis.

Many thanks to all the members of this forum and all my admiration for you.
 

Nikki J

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Awaji’s criteria do not mean if you twitch. There is a particular type of waveform seen on emg that they are referring to. It is called a fasciculation potential and even then it needs to have certain characteristics to be concerning. Since you apparently have your emg report you should be able to see that those are not there. They may have noted they saw fasciculations. That isn’t the same thing.
 
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