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Neurology (Expert Forum)
Muscle Spams? Back probmes? ALS? So Scared
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury
Muscle Spams? Back probmes? ALS? So Scared
by utnd, Jun 26, 2006 12:00AM
Hi. I am a 25 yr old healthy female. Since October I have had really weird symptoms. Lots of muscle spasms throughout entire body - back, legs, arms,lots in the stomach area-mostly after streching. I also have two eye floaters that developed at the same time. I have no weakness at all and I have been seen by my neuro twice, He did an MRI of brain, neck and back. All ok except for protruding and bulging discs- I have a L4-5 bulge and disc protrusion of thecal sac. I have an intense burning everyday-worse when sitting that moves down rt leg. Dr. ordered EMG and the results are as follows: Motor nerve conduction studies normal. F-wave studdues w/in normal limit. There is slight prolongation of insertional activity throughout medial solcus musculate (rt leg only) and... The right posterior tibila H-response was slightly prolonged. (rt leg only) There was "electrophysiological evidenece of Membrane instability/inflam process involving S1 root. I was ultimately diag with lumbosacral radiculitis. This diag was given by GP; however, neuro does not think my back is bad enough to cause this EMG result. He thinks the inflamed nerve is caused by something else but does not know. My chiro is convinced protruding disc is the expalnation for the pain/EMG.
My neuro said I do not have ALS. You are very strong he says. Do these EMG results point to early ALS??? I think I am scared b/c of the EMG. Does this sound like ALS with no weakness at all? Could this me a disc nerve problem that got worse after MRI of back? What else can cause only one nerve S1 to be unstable or inflamed PHN
My neuro said I do not have ALS. You are very strong he says. Do these EMG results point to early ALS??? I think I am scared b/c of the EMG. Does this sound like ALS with no weakness at all? Could this me a disc nerve problem that got worse after MRI of back? What else can cause only one nerve S1 to be unstable or inflamed PHN
Doctor's Answer
by CCF-Neuro-M.D.-PW, Jun 26, 2006 12:00AM
I cannot comment specifically on your EMG without seeing the report, andalso it is a very subjective test and can be interpreted differently by different people.
Prolongation of the H response is a feature of an early nerve root problem - it is not a good test for the motor neurons in the spinal cord that are affected in ALS. THe F waves are a more specific test for these neruons and they seem to be normal. EMG evidence of ALS would be more like increased insertional activity and evidence of denervation which you do not seem to have. Also one needs to see these findigns in at least 3 limbs. Widespread muscle spasms and buring pains do not suggest ALS either - ALS affects the motor neurons and spares the sensory system.
MRI does not always correlate with pain symptoms especially in mild nerve root problems. It will also not show non-structural (ie discs, bony spurs) causes of a nerve root problem such as seen in people with diabetes, cetain types of infections, or some rare conditions such as Lyme disease or a paraneoplastic syndrome. Ask your doctor about the likliehood of these conditions.
Prolongation of the H response is a feature of an early nerve root problem - it is not a good test for the motor neurons in the spinal cord that are affected in ALS. THe F waves are a more specific test for these neruons and they seem to be normal. EMG evidence of ALS would be more like increased insertional activity and evidence of denervation which you do not seem to have. Also one needs to see these findigns in at least 3 limbs. Widespread muscle spasms and buring pains do not suggest ALS either - ALS affects the motor neurons and spares the sensory system.
MRI does not always correlate with pain symptoms especially in mild nerve root problems. It will also not show non-structural (ie discs, bony spurs) causes of a nerve root problem such as seen in people with diabetes, cetain types of infections, or some rare conditions such as Lyme disease or a paraneoplastic syndrome. Ask your doctor about the likliehood of these conditions.
I am a 36-year old male (birthday today) and have a similar background. My twenties were spent trying to find the cause of increasing lower back pain. About 8 years ago, I was finally diagnosed with an agressive degenerative disc condition. Dr. says the damage was most likely caused by a virus. He did a spinal tap of the L5-S1 region of my back to get spinal fluid for testing and to make sure the area was indeed the root of my pain (agony more like it). I had a SEVERE reaction to the spinal tap. The hole that the needle made did not close and for 3 days, I laid in the hospital until a "blood patch" successfully ended the reaction. While in the hospital, they took a CT scan of my entire body to see why I had reacted so violently to the spinal tap--they are naturally painful, but I was in a state of pain that no combination of drugs could even take the edge off. The CT scan revealed a pituitary tumor. I had no symptoms that would point to a tumor, however, it was possible that I was in such agony with my back, that I didn't notice any symptoms. I had the tumor removed, and 5 weeks later had the back procedure that I was scheduled for prior to the tumor being discovered. The back procedure I had was called Intra-Discal Electro Thermal Ana-something (IDETA). I felt some relief for about 6 months, then the agony returned. About a year after the IDETA, I had a fusion of the L5-S1. The surgery was successful. Immediately upon waking up from the anesthesia, I felt a huge relief. The relief was so profound that I did not even notice the surgical pain--that is how bad I was hurting before the surgery. About 6 months later I got back in the gym and swimming pool and got in the best shape of my life. All was well until about three years ago. I began having restless legs at night. It was so bad, I could not sleep for more than about 5 minutes without jerking myself awake. Dr. gave me Klonopin, and it worked quite well. Important note: Between the successful back surgery and the onset of my restless legs, I did not require or take any prescription medication for pain. The restless legs continued to be controlled by the Klonopin, then about two years ago, I began to develop hand tremors, muscle twitches, speech problems, trouble concentrating, pain in the major muscle areas, and more pronounced restless legs. Dr. gave me propoxyphene (Darvon) for the pain and said it would help with the increased restless leg problem. About once every 2-3 months, I would have severe pain episodes requiring Urgent Care visits for pain shots. Sometimes they were brought on by overworking, and sometimes they just showed up for no reason. I finally saw a Neurologist last Friday. He was very meticulous and interested in my problems. He prescribed Neurontin at night, and scheduled me for an EMG exam. The first morning after taking the Neurontin, I noticed a lessening of my hand tremors. Also since I have been on it, I have not had one muscle twitching event. Last Tuesday, I had my EMG exam. Like the spinal tap years before, I reacted badly to the test. It put me into a major pain episode requiring a shot for pain management. Based upon my EMG results and reaction, and the apparent success of the Neurontin, The Dr. diagnosed me with Benign Cramp Fasciculation Syndrome. My first question was "What causes this problem?" The answer was the same as with my degenerative disc disease: most likely a virus. I am somewhat relieved knowing that the alternatives to this diagnosis were either ALS, Parkinsons, or MS. Now the source of the virus. When I was 17, I had a high fever for about two weeks. This was just after a camping trip to the High Sierras in California. My mom took me to the Dr. after a couple of days of having a high fever. Dr. said I had the flu and to go home and get rest. After a week of having this fever, my mom took me back to the Dr. where he "guessed" I may have Mono and that it would go away. Eventually, the fever went away and I went back to regular activity. I think the source of my medical problems was the undiagnosed fever/virus I had when I was 17. I was so sick that I actually slept for 40 hours straigt. No food, restroom visits, etc. I also halucinated when the fever