EMG follow up

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PatMac

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Hi, thank you for taking the time to read this. I read the important notices at the top of the forum and I didn't want to post until I was able to see a neurologist. If you could please give me your feedback I would really appreciate it.

I made an appointment because I was experiencing body wide twitching for the past 6 months or so and I was worried and wanted to get checked out. My neurologist sent me for a blood test and then gave me a full examination. He said my CK levels came back "a bit elevated" at 206 and that my all my reflexes were "a bit brisk". He then gave me an EMG of my upper body, and the results are posted here. The EMG was mid-March. At the end of the exam, he said he didn't see anything that concerned him. My insurance plan has a very high deductible and he told me he didn't want to do more tests than he needed to do.

Since then the twitching has remained the same but I've been getting a new symptom which I can only describe as something in the back of my throat slamming or flapping shut (soft palate?) sometimes when I go to blow my nose or force air out of my nose, which stops the air from going out. Sometimes it seems to catch when I go to speak. All I need to do to correct it is swallow, and I'm not slurring my words or anything, but it's making me consider going back to have my bulbar region checked, as I'm not sure if this is "weakness" or not. Looking in the mirror, I can see my palate raise symmetrically when I say "ahhh", but I don't know what else it could be.

I guess my questions are:

1. is a 206 CK level with "a little brisk reflexes" something to worry about?
2. based upon the results of my upper body EMG, does this clear me or should I go back and have my bulbar region checked?
3. has anyone heard of the issue with something slamming shut at the back of the top of the throat that briefly stops the air from coming out of the nose in connection with a bulbar issue?

As the important note says, I don't want to take valuable clinic time away from other people, so I guess I'm just looking for some feedback on whether the members think I should go back and have my bulbar region checked. Thank you. I know you all aren't a substitute for a doctor, but opinions from those who have experienced this first hand could really put my mind at ease.
 

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That EMG is completely normal. Normal EMG = no ALS.

Twitching is common, nonspecific, and meaningless.

That CK is fine. CK has a broad normal range, and 206 is not pathological.

Brisk reflexes can be a normal variant for some people.

What you describe doesn’t sound like bulbar symptoms. A normal EMG even in the limbs is adequate to rule out bulbar ALS, because in ALS the EMG abnormalities are widespread and picked up early.

So, nothing in your post suggests ALS. Time to celebrate!
 
Great news!

You're clear.
 
The nose/throat air thing sounds like allergies and/or a sinus issue. You could try fexofenadine and a nasal steroid empirically, in consultation with your PCP.

I agree that you have nothing to worry about in terms of neuromuscular disease. If you had bulbar issues, something would be amiss with the upper body EMG, as is the hallmark of ALS.

Best,
Laurie
 
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