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ekernan

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I am new here. Very scared and need some wisdom. I am a 35 year old female with a 41/2 year old daughter and a 4 month old son. I've been through a lot this past year, but I'll make a long story short...

I have significant quadricep atrophy in my left thigh that I noticed about a year ago. No clinical muscle weakness although I personally feel weak with twitching in all four limbs and tongue and lots of muscle pain/ cramping. My reflexes are "jumpy" but within normal range for my age (according to my neurologist). I have been through numerous MRIs, blood tests, 3 EMG/NCV tests, with the last one being at a teaching hospital/ ALS clinic. Here is the report:

There is electrophysiological evidence of mild chronic denervation changes in the left lower limb. (A few polyphasic motor unit potentials were seen in left TA and left vastus lateralis muscle. Motor unit potentials with increased amplitude were seen in the left vastus lateralis muscle.)

No evidence of active denervation was seen.

Compared to the study in Feb. 2011, the active denervation in tibialis anterior is not seen.

I guess I am looking for some reassurance that this is not ALS and also am wondering if other limbs should be tested to look for active denervation or if this is enough evidence to rule out ALS (since they tested the affected leg with atrophy)? Only two muscles were tested though and I'm concerned that maybe other muscles might have shown active denervation. I don't know... any wisdom would be appreciated. I am very scared.
 
You really need to ring your doctor up and ask him these questions. It's easy, he will be able to explain exactly what they mean better than anyone here, except Wright. Instead of worrying, go straight to the source. I feel if he thought it was worrying he would have said so, but make sure.
 
There is a member on here by the name of Wright who will be able to interpert your results and educate you. What I can tell you if I am reading what you wrote correctly is that there are very positive signs that point away from ALS. The two things that stick out to me is no clinical muscle weakness, no weakness = no ALS, and your report stated no evidence of active denervation. Again I am far from an expert but from what I have read and learned is that no denervation means no ALS.


The most important thing to do is to follow up with you Dr's they are the one's will truly be able to help you.
In the mean time reach out to Wright if you want, I hope my answer helps ease your anxiety.

Best of luck!
 
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Go to search, then advanced search and under posts by user name type Wright, then find his name and leave him a visitor message. There is probably an easier way but this is the only way I know of.
 
Thank you, Ted. I love Padre Pio. Have you seen the movie by Ignatius Press? Beautiful movie of his life.
 
Reflexes within normal range and a clean clinical exam sure point far away from ALS. No weakness another factor to point far away away away from ALS.
 
I got your visitor message and so I thought I'd respond to you here in case anyone else is interested.

I'll start by saying that I agree with everyone on here and your neuro: your tests do not in any way indicate you have ALS.

It sounds like your previous EMG showed some active denervation (i.e. some peripheral nerve damage . . . nerves that control your muscles). Then in your latest EMG, that active denervation was not seen, which means the nerves had healed. More evidence that the healing process had taken place is the increase in amplitude of your motor units (that is a sign of reinnervation, a sign of nerves healing).

People with ALS will have both active denervation and reinnervation until the nerve has been completely destroyed. That is not at all what you have. Furthermore, you have no weakness and the rest of your clinical exam was unremarkable.

Add all of that together and it indicates you do not have ALS. Something damaged your nerves at some point and then they healed. It's as simple as that.

Go enjoy your holidays, your family and your life.
 
Thank you so much for your explanation, Wright. I appreciate you taking the time to reply to my message. I have a couple more questions and then I'll let it be. What does "polyphasic" mean? And do you think I should have other muscles tested since my previous EMG showed denervation in other muscles as well? Or do you think the absence of denervation in the atrophied muscle is enough to rule out ALS? (I have significant muscle pain in the quadricep muscles in both legs and lots of twitching in my feet, legs, arms, and hands.) I'm just so terrified that it's hard to let it go....
 
Again, your EMG's viewed as a whole do not in any way indicate ALS. Stop taking bits and pieces of your story and extrapolating them out to places they simply do not belong.

Polyphasic potentials indicate restructuring of motor units and that restructuring can occur because of damage to axons. A motor unit is made-up a group of muscle cells and the axon that innervates/controls them (axons make-up nerves . . . think of a rope as a nerve and the individual stands in the rope as the axons). How that information helps you is beyond me, because what I have just explained to you is more than likely waaaaaay over your head and will in no way benefit your understanding of what has happened to you.

Bottom line: it doesn't matter what polyphasic potentials indicate and I have already explained why. You don't need another EMG, unless you have money to burn and time to waste. Your EMG and story do not in any way whatsoever indicate you have ALS. End of story!
 
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