Yes, I looked through 5 reports dating back to 1982. Unfortunately, none of them had any clearcut data as to when or if they they had the EMG prior to the development of weakness. Now keep in mind this was before the age of the internet and before people had widespread knowledge about ALS, fasciculations, and BFS. So I suspect that these patients who started out with twitching did not seek attention until after the development of other neurological problems such as weakness and wasting. Thus, their workup (including the EMG) was likely not done until after other more characteristic symptoms of ALS developed. So to make a long story short, as I stated before, I would tell my patients who had twitching in the setting of a clean EMG and exam that they did not have ALS. And although it's not clear as to exactly when the EMG was done in those brief reports of patients who presented with fasciculations first, it's very likely that they had the workup done after the other signs of ALS had set in(based on the fact that most people at that time didn't know the significance of muscle twitching and probably didn't seek help until later).
Hope that answers your question.
This is very reassuring. Thank you for your time!
Mike