Abnormal EMG

[RedSoxFan]

I am a 52 year old male who was diagnosed with sarcoidosis about a year and a half ago, based on chest x-rays and skin biopsies. At the time, I was experiencing some neurological symptoms (cramping and twitching in my feet and calves). My neurological exam indicated brisk reflexes and I was given an MRI of the brain and neck. There were several white matter lesions on the brain MRI and I was referred to a noted neurologist in Boston for a second opinion. He stated that the lesions were inconclusive but he believed that my sarcoid was still active.

About two months ago, I complained to my primary care physician of weakness in my left hand and arm. He noticed atrophy of the muscles around my thumb and consulted with my neurologist. I was scheduled for an EMG in a Boston hospital. On my return visit to my neurologist, he confirmed the weakness and atrophy, noticed some twitches in my hand, and informed me of the EMG results - "significant abnormalities consistent with Left Ulnar neuropathy". He also noticed what he called "thick speech" and I told him that my wife had made the same comment recently. He also asked about my neck and I said it felt a bit stiff recently. Now I am scheduled for an EMG of the tongue in a few weeks. He also ordered some blood work. One of the tests (Co-GM1 Triad Autoantibody) supposedly detects multifocal motor neuropathy.

Just last week, I thought I was having a stroke. A portion of the left side of my face went completely numb for about five or ten minutes and I noticed problems speaking. I was given a diagnosis of Bell's palsy and I am now on prednisone and acyclovir.


Q1. I was taking 30 mg. of Prednisone a day at the time of the brain MRI. Could that make a difference in the intensity of the white spots?
Q2. I have seen ALS listed in the differential diagnosis for ulnar neuropathy. Given the "thick speech" symptom, will a positive GM1 autoantibody test rule out ALS?
Q3. Is the facial weakness that I’m experiencing consistent with neurosarcoidosis?

Thank you.

[CCF-Neuro-M.D.-CS]

The prednisone may impact on the MRI, but not necessarily. They should be able to evaluate for sarcoid. The GM1 anti-body does not test for ALS, and does not exclude ALS. However, your history would not be typical for ALS. Determining if this is related to sarcoid would be the first step. Sarcoid can affect the brain, and in the brain typically presents with nerve dysfunction. Therefore, the facial weakness could be the results of neuro-sarcoid. This can be seen on an MRI, or by doing a spinal fluid analysis and looking for a marker of sarcoid (an ACE level). Good luck.

[pastor mark]

I have been diagnosed with cramp muscle fasciculation syndrome ,  i'am 49 years old , this has been 4 yrs now , i had 3 emg's done which came back positve and also checked out positive for epstein bar . i have taken numerous, medications  with no relieve until my medical doctor started me on tizanidine 4 mg. i would like to know if you have any new information on this disease????  thank you pastor  mark

[lorih1]

A related discussion, definition of a normal EMG test was started.