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Neurology (Expert Forum)
Abnormal EMG Question
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Abnormal EMG Question
by DMINOTMAN, Feb 23, 2005 12:00AM
I’m a 42 y.o. male concerned about abnormal EMG results and possible ALS. I’ve had the following sx’s since Nov 2004:
Constant fasciculation’s - right calf
Occasional fasciculation’s - left calf/hamstrings/thighs/arms/back/butt/neck/left rib area/jaw/lips (all worse with exercise)
Occasional cramping – calves/feet/hands/hamstring/neck
Difficulty swallowing post nasal drip
Occasional muscle pain – hands/feet/legs/arms/back/neck
No weakness/atrophy or difficulty swallowing food/liquid
I saw a local neurologist in Dec/Jan and one at the Mayo Clinic in Feb. My labs/EMGs/MRIs/physical exams were normal except for moderate/severe central canal stenosis and disk herniations on the lumbar spine MRI and the second EMG showed fasciculation potentials, with varying, long duration, complex MUPs in a right L5, S1 distribution, with fibrillation potentials only seen in the gluteus maximus. There were varying MUPs noted in some right upper extremity and left cranial innervated muscles, without abnormal insertional activity. Single fiber EMG of the right deltoid, was normal with no increase in jitter detected (14 muscles were tested).
Mayo neurologist said evidence does not support a motor neuron disease. He diagnosed me with benign fasciculation’s, lumbar stenosis and anxiety. He wants to repeat EMG in 6 months.
1. Can this be bulbar onset of ALS?
2. Would you expect to see some weakness or other abnormalities on the EMG if this were ALS by now?
3. What else can cause such abnormalities on EMGs?
4. Does the above information support a dx of BFS?
Constant fasciculation’s - right calf
Occasional fasciculation’s - left calf/hamstrings/thighs/arms/back/butt/neck/left rib area/jaw/lips (all worse with exercise)
Occasional cramping – calves/feet/hands/hamstring/neck
Difficulty swallowing post nasal drip
Occasional muscle pain – hands/feet/legs/arms/back/neck
No weakness/atrophy or difficulty swallowing food/liquid
I saw a local neurologist in Dec/Jan and one at the Mayo Clinic in Feb. My labs/EMGs/MRIs/physical exams were normal except for moderate/severe central canal stenosis and disk herniations on the lumbar spine MRI and the second EMG showed fasciculation potentials, with varying, long duration, complex MUPs in a right L5, S1 distribution, with fibrillation potentials only seen in the gluteus maximus. There were varying MUPs noted in some right upper extremity and left cranial innervated muscles, without abnormal insertional activity. Single fiber EMG of the right deltoid, was normal with no increase in jitter detected (14 muscles were tested).
Mayo neurologist said evidence does not support a motor neuron disease. He diagnosed me with benign fasciculation’s, lumbar stenosis and anxiety. He wants to repeat EMG in 6 months.
1. Can this be bulbar onset of ALS?
2. Would you expect to see some weakness or other abnormalities on the EMG if this were ALS by now?
3. What else can cause such abnormalities on EMGs?
4. Does the above information support a dx of BFS?
Doctor's Answer
by CCF-Neuro-M.D.-CS, Feb 24, 2005 12:00AM
I cannot give you a clinical diagnosis over the internet
if it is bulbar ONSET als, then your only symptom is the difficulty swallowing postnasal drip - this is then unlikely
your EMG results can be consistent with an L5/S1 radiculopathy (pinched nerve roots)
Fasciculations in the absence of muscle weakness or wasting is unlikely to be ALS. Also, benign fasciculations are more likely to be widespread from onset, as you describe
In any case, as time is one of the best diagnostic tools of the neurologist, a repeat EMG in 6 months will hopefully confirm or refute the diagnosis.
Good luck
if it is bulbar ONSET als, then your only symptom is the difficulty swallowing postnasal drip - this is then unlikely
your EMG results can be consistent with an L5/S1 radiculopathy (pinched nerve roots)
Fasciculations in the absence of muscle weakness or wasting is unlikely to be ALS. Also, benign fasciculations are more likely to be widespread from onset, as you describe
In any case, as time is one of the best diagnostic tools of the neurologist, a repeat EMG in 6 months will hopefully confirm or refute the diagnosis.
Good luck
Member Comments (2)
by BMNS, Feb 23, 2005 12:00AM
HI! Check out the Benign Fasculations web site at www.AboutBFS.com. It is a wonderful support site for BFSer's. Your symptoms mirror those of other BFSer's. I don't think you have ALS and this website and the people who use it will provide lots of knowledge and comfort to support this. Relax...your neuro is on target! Take care!
