EMG Nerve Conduction results

Question

Hi Dr.,

I hope I'm posting on the right forum.

I recently went to a neurologist due to longterm muscle weakness, nerve pain and twitching - a little muscle spasm especially in feet. Like 100s of other people, I did a search and my concern was ALS. I was found however to have vitamin E deficiency, my level being "0.4" with the range beomng 3.0 to 16.0. Previously I was found to also be vitamin D deficient and low-normal on B12. All of these are being treated now.

My neuro has already told me that my symptoms don't indicate ALS and while I know you cannot give definitive answers without in-person evaluation I would like to know if you concur with his opinion, that I instead likely have a form of peripheral neuropathy of the axonal type.

First of all, I know for a fact my muscle weakness has been occurring for at least five years but worsened the past couple years or so. Despite weakness and neuropathy type symptoms, I have yet to see any atrophy in my muscles and my CK and other muscle enzymes tested late this past month were all normal range (usually below mid-range). I also tested negative for other muscle diseases and for lyme.

Now to the EMG/Nerve Conduction:

Four groupings of muscles in my upper extemities and four groups in my lower, were needle electrode tested and all were given "normal" status. There also were no fibs, PSWs or Fascs found in them. That last one suprized me because I do experience some muscle twitching in my hands and feet.

His comments of importance:

""mild to moderate drop in amplitude in the CMAP of peroneal and tibial nerves and left showing the median and ulnar...SNAP reveals low aplitude especially in the surals ... conduction velocities are in low-normal and slightly below normal, slightly prolonged on the left tibial...latencies are preserved...H reflexes are symetrical...reflexes are hypoactive...the needle study does not reveal acute or chronic denervation."

CLINICAL IMPRESSION: "The study reveals drop of amplitude and conduction velocities in the lower range of normal, consistent but not diagnostic of axonal peripheral neuropathy."

QUESTION: "Do these type readings point to something other than ALS?"

THANK YOU!

anuragsrivastava · Accepted Answer

Hi, Thank you for your question. Your muscle weakness symptoms could occur due to injury to a nerve, pressure on spinal or peripheral nerves (neuropathy), vitamin deficiency, lack of blood supply due to cholesterol plaque from atherosclerosis in the extremities, viral infection and use of certain medications. In addition, atherosclerosis can also cause pain, numbness, and tingling while walking and they can also reduce blood supply and lead to numbness or weakness. Please consult your doctor to get all these possibilities evaluation in your case for further assessment. Hope this helps.

kemraj · Answer

My MRI revale opll and myelomalaicia. are those symptons treatable .I am 60 years old .I am haveing lots of pain . my company still insist that i work .I am home for 10 weeks and no one wants to pay

LowMac · Answer

Thanks much for the quick reply.

My lipids, including LDL and triglycerides were normal but realize this doesn't necessarily rule out atherosclerosis. I am following up with my neurologist and regular MD.
I knew about the other possibilities, including my vitamin deficiencies but was hoping aspects of my EMG/Nerve Conduction, revealed result-aspects that are not typical of a severe neuromuscular degenerative disease such as ALS.

If you happen by my thread and can add to this specific of my question originally posted, I would be grateful and hoping that by no means it appears that I'm putting you on the spot.

I'll go ahead and say that it's my understanding that PSWs (positive sharp waves), Fibrilations and Fasciculations are prominent results on needle EMG studies, which mine did not have. 

Thanks again.