ALS?

[Tommy757]

EMG & NCV Findings:

Evaluation of the left Peroneal nerve showed prolonged distal onset latency (6.6 ms). The right peroneal motor nerve showed prolonged distal onset latency (5.8 ms). The left Saphenous Anti Sensory nerve showed reduced amplitude (2.5 uV). The right Saphenous Anti Sensory nerve showed peak latency (3.7 ms).  The left Sup Peroneal Anti Sensory nerve showed reduced amplitude (4.7 uV).  All remaining nerves were within normal limits.

All F wave latencies were within normal limits.  All H Reflex left vs. right side latency differences were within normal limits.

All examined muscles showed no evidence of electrical instability.

Impression: No evidence of lumber radiculopathy, peripheral neuropathy, or peripheral nerve entrapment.  There is a mild Peroneal neuropathy seen bilaterally, etiology unknown.  Patient will be going for a lumber MRI in January, which may be helpful.  His symptoms are consistent with lumber stenos is.

I had the MRI today and the orthopedic doctor told me there was nothing there causing my symptoms.  

I began having balance problems (walking but feeling like I might fall down) last August 2006 - went to my primary care Dr. he told me I had fluid in my ear and gave me some meds, that went away and then I began to have headaches daily for 3 months and then they went away.  I was fine for about a month but then in February 2007 I started feeling weakness and stiffness in my legs and when I walked almost a feeling of un-coordination and that my foot would hit the ground but it would take a second before my leg would be stable and I've had a stiff neck, lower back burning and discomfort and some mild balance problems and fatigue.

Since February I have been to an ENT who tested me for allergies and told me I have level 3 allergies to dust and mold and gave me allergy drops.  ENT also tested me for sleep apnea - said I had a mild case and gave me a mouth piece to wear at night.  I've had 2 sinus CT scans which revealed a deviated septum with a nasal bone spur.  In March I had a brain MRI which came back "clean"/"unremarkable".  I have also been to a chiropractor would told be I have subluxation in my neck and lower back - have been seeing him for 5 months and still have symptoms.

I have had an MRI of my neck and lower back – came back ok.

Went to the Neurologist and he examined me and said I was fine.  I had a nerve conductivity study done and it said the return of electricity back was slow in the peroneal nerve  in both legs, everything else was fine no nerve damage.  What could this be?  What other tests should I have done?

[JainMD]

Hi,
EMG findings are not pathognomonic of specific diseases and do not in themselves provide a definitive diagnosis.
Motor neuron disease including ALS would usually present with common initial symptoms is weakness, muscle wasting, stiffness and cramping, and twitching in muscles of hands and arms. Legs are less severely involved than arms, with complaints of leg stiffness, cramping, and weakness common.
Needle EMG and nerve conduction studies are the tests of choice for confirming the diagnosis of ALS. The confirmation of ALS is facilitated by demonstrating diffuse denervation signs, decreased amplitude of compound muscle action potentials, and normal conduction velocities.
Is EMG study been done?
Keep me informed.
Bye.

[Tommy757]

The results of the EMG on my legs are in the 1st paragraph

[JainMD]

Hi,
Your EMG studies show there is no evidence of electrical instability.
There is no objective evidence of ALS on EMG studies.
I think it is neuropathy involving your peroneal nerve.
Lumbar MRI would help in further evaluating regarding any pathology originating from lower back.
Hope this helps.
Bye.

[Tommy757]

Thanks, I'm relieved to hear that there's no evidence of ALS - but I had an MRI of my lower back and it didn't show any causes for my symptoms.  What else could this be?

[NicoleHope]

Tommy, I have had a similar road myself, and my balance issues ultimately ended up being contributed to the medication I was on which was causing neurotoxicity. Are you on anything right now? I was on two anti-depressants and ambien.

[JainMD]

Hi Tommy,
As per your NCV reports, there is latency in your common peroneal nerve conduction. This could be due to compression of nerve around knee joints.
This compression of nerve could be due to fibular head, along the course of peroneal nerve.
It can be managed conservatively, but compression has to be avoided.
Hope this helps.
Bye.

[Tommy757]

Thank you so much - ALS was my biggest fear now I can put my mind at ease and ask them to check my legs

[JainMD]

Hi Tommy,
I feel nice that I could be of some help to you.
Which doctor are you planning to consult? When is your next appointment?
I would recommend you to see an orthopaedician at earliest and get imaging study done for your lower limb.
You should also for electro-diagnostic studies if diagnosis is still doubtful.
The Electro-Diagnostic studies examination ordinarily comprises electromyography (EMG) and nerve conduction studies (NCSs).
Keep me informed about the disease progression and also what doctors have to say.
Bye.