What is a clean EMG in layman's term?

[SidVicious]

Hi.

Im a 34 yo female. Sorry this is going to be long, but I think a history is in order.

- my symptoms started last feb 26 2010. I had shooting pains in my left arm, felt like the ulnar nerve being irritated, and the cramp diffusing to the whole left arm and hand. it lasted for several days and had pins and needles on my left hand. this went away after a few days.. but the exact same feeling was felt on my right arm after a few days.. and also on my left and right knees after a few days. the pain and cramping would be aggravated by use.. although not all the time.

- then i suddenly developed sensitivity on all my teeth.

- i was experiencing electrical shooting pains in my face and head. there were instances that when it is hurting, even a slight touch would jar me like electricity.

- and since nerve pain and pins and needles are my main complaints, i figured MS, since after research, i figured ALS does not cause this type of pain. I consulted several neuros (since others would dismiss me as just imagining things, when i know i'm not i went to several neuros)

- my two last neuros ordered the following:
brain MRI, cervical spine MRI, EEG, lab tests for blood sugar, creatinine, ANA, FT4, FT3, TSH, B12


ALL were normal, except for the following:

- My cervical spine MRI showed : small ventrical disc bulges seen at C3-C4 and C6-C7 interspaces, the annulus fibrosus is not completely disrupted. However small central disc annular tear/fissure formation is noted at C3-C4 level.

- my TSH is .793 (normal values are .340 - 5.60 (still within the normal but on the very low side.)

- my creatinine LOW, at .60 (normal values are .70 - 1.50)

- my b12 is 444 (normal values 243 - 894) (within normal but on the low side)

so he said i don't have MS or other types of diseases with respect to the lab tests made.


Sorry for the long story, I just want to make sure I've narrated everything, and that I've done my research and lab tests and doctor consultations, so that i don't waste anyone's time.

btw, i used to take gabapentin for nerve pain, which is now changed to cymbalta by my last neuro. i'm also taking methycobalamin 1500mcgs.



So now here's why I decided to post here on alsforums.

These are my current symptoms which are driving me out of my mind:

approximately last april 16 my fasciculations ALL OVER the body, started. They were everywhere.
there are days when there would be so much, and days when they are almost silent.

Then I noticed on both hands, the place between my thumb and forefinger has atrophy.. also my left thumb has dents in it (like what AndyDJX has said). And when i use my hands and feet (like when im driving, it would cramp although VERY LITTLE).

Besides the atrophy on my palms, although I CAN'T REALLY SEE it, I ONLY FEEL that the heel of my LEFT foot also has atrophied since sometimes it's uncomfortable to walk, as if the pad of the feet is so thin. But I am not weak anywhere.


The fasciculations, i can bear but the atrophy although not much, is scaring me out of my wits. WHAT CAN CAUSE THIS ATROPHY? I'm suppose to be reviewing for the bar and taking care of my 2 year old daughter, after being healthy all my life, in just less than 3 months, this ALS thing has really messed up life. I can't function any more. I am hopeless. I cry everyday thinking about what will happen.


I am already having fasciculations and atrophy when I decided to have an EMG - NCV just this May 5, 2010. This is where I don't understand what you guys mean about a clean EMG. Following are my results: ( I HOPE WRIGHT CAN SHED A BIT OF LIGHT ON THIS. THANKS)

All were normal except for the following:

1. Low amplitudes of the CMAP of the R Peroneal. Except for this, all other NCV studies of all nerves are within normal.
2. Normal Tibial H-reflexes
3. EMG of the L paraspinal at L3,4,5,S1 did not show any denervation
4.EMG of the L paracervical at C3,4,5,6,7 did not show any denervation.
5. EMG of the L Ant Tibial and R MEdial Gastrocnemius showed mild to moderate numbers of fibrillation potentials and positive sharp waves suggestive of chronic denervation. EMG of the 1 Rectus femoris showed normal findings. There were no fasciculation potentials.
6. EMG of the L Biceps Brachii, L abd poll brevis, and L first dorsal interosseous did not show any denervation, The L ext dig communis showed mild to moderate chronic denervation. There were no fasciculation potentials seen.

Impression:

1. A mild to moderate axonapathy involving mainly the motor radial, peroneal, and tibial nerves.

2. There is no evidence for a demyelinating neuropathy

3. There is also no evidence for a motor neuron pathology at this time.

4. EMG of the L paraspinal and L paracervical muscles did not show any evidence of radiculopathy.

----


I asked my neuro if I have ALS, he said no. That i only have some form of peripheral neuropathy. He said he doesn't know what causes it. I asked him if i need to do other tests to check what is causing the atrophy, he said there were no tests.

So i am left here watching my body waste away. I HATE the fact that I can only observe and go on a nervous breakdown each night, without doing anything about it. He said maybe a post viral is causing my neuropathy but is not really convinced about it. He didn't offer any other tests to see what is causing this neuropathy IF IT REALLY IS NEUROPATHY!

If the atrophy and or fasciculation is being caused by a peripheral neuropathy, or axonopathy, i want to know what it is so that i can treat it if there's treatment available.

But what worries me is if the cause is not really peripheral neuropathy or axonopathy but ALS.



SO finally, here are my questions:

Based on my results, CAN YOU CONSIDER MY EMG CLEAN, given the fact that the Neuro who EMG'd me and my original neuro told me I don't have ALS? Although they did notice denervation? and noted that no motor neuron pathology 'AT THIS TIME' ?

following is the chart of the abnormal lines:

SIDE - MUSCLE - NERVE - ROOT - INS ACT - FIBS - PSW - AMP - DUR - POLY - RECRT - INT PAT - COMMENT

Left - Ant Tibialis - Dp Br Peron - L4-5 - Nml - 2+ - 3+ - Nml - Nml - 3+ - rapid - 75% - denervation



Right - MedGastroc - Tibial - S1-2 - Nml - 1+ - 2+ - Nml - Nml - 3+ - Reduced - 75% - denervation


Left - RectFemoris - Femoral - L2-4 - Nml - Nml - Nml - Nml - Nml - 2+ - Nml - Nml - no denervation


Left - ExtDigCom - Radial (post int) - C7-8 - Nml - 1+ - 2+ - Nml - Nml - 2+ - Reduced - 75% denervation




This atrophy, fasciculation and EMG is killing me. Everyday is torture. My relationship with my husband is suffering. I can't review. I can't take care of my child.

I used to be an atheist but now I pray to God that this is self limiting and that it is really nothing. Or something curable.

I plan to get another EMG in the next few weeks to see if they will see a change in my EMG. I'm close to breaking down.

 

[halfin]

I'm very sorry that you are feeling so poorly. It looks to me like your EMG is not what we would call clean, but that doesn't mean you have ALS. Your neurologist diagnosed peripheral neuropathy. That would fit better than ALS since as you said, ALS does not cause sensory symptoms but neuropathy can.

It sounds like a good next step would be to see a different neurologist to confirm the diagnosis, and hopefully find a doctor who will be more proactive and caring in helping you deal with this condition.

Clearly you are under great stress. That can produce twitching and may well be making your symptoms worse. You need to try to let go of this worry about a very rare disease which an expert has told you you don't have. I know it is not easy, but at this point I don't think you have any reason to worry about ALS.

 

[ktmj]

SV, I can't comment on the NCV/EMG intelligently, but I do want to ask if it was done at a neuromuscular clinic or teaching university, or a local neuro.

Specialists see much more of the "odd" things, and there are neuropathies that cause atrophy and your other symptoms. Best wishes.

 

[wright]

The reason your neuro doesn't think you have ALS, is because your story and EMG don't add-up to ALS. It's as simple as that. I'm not sure why it is that you're questioning your neuro's diagnosis. It appears that you have been evaluated fully and extensively.

My guess is that you don't fully believe him, because he hasn't given you the reason behind your neuropathy. Sometimes things in medicine are what they term "idiopathic" which means the reason behind them is unknown. This happens more than you think.

My question to you is . . . if you don't feel you have a peripheral neuropathy . . . why is it that you have latched onto ALS as the only alternative diagnosis? Don't you feel that's a bit extreme, especially given that your story doesn't point towards it?

Do your best not to torture yourself any longer, because it appears to me that there isn't really a reason to do so. I'm certainly not dismissing the fact that something is happening to you, but it doesn't appear to be life-threatening to me . . . life-changing obviously . . . but not life-threatening.

Now go study and more importantly, go enjoy your family. I wish you peace.

 

[SidVicious]

Thanks for all the replies. Wright, you are very right on the reason why i have doubts on my neuro's diagnosis..

Just came from the new neuro after several weeks of torture and i have an update on a separate thread, hope you guys won't get tired of my inquiries. You don't know how much you guys are helping me.. Thanks much