EMG conclusion

Hi Dr,

Ive had als for 5 years now since I was 22 yrs old, I had a emg 4 years ago which was normal, in 2000 i received a second emg which showed denervation resulting in a als diagnosis. I had another emg/ncv test on the 13th sept 05, The man whom performed the test said there was some emg improvements, is it normal for a emg to improve in als ?

I have received the full report but can not understand what it means, please can you tell me what the below conclusion means in laymen terms. many thanks

Conclusion

Dear.........

Thank you for re-referring this young lady who possibly has an unusual variant of MND. She has a combination of lower limb spasticity, pseudobulbar palsy and lower motor neuron signs in the upper limbs.
Previous emg was in 2002. Motor evoked potentials have also been shown to be absent.

Sensory findings remain unchanged. Motor amplitudes are small in the upper limbs and have not significantly changed compared to 2002. In muscles with absent F waves, I searched for a conduction block with a stimulation at Erb's. Conduction block was not observed in any of these muscles, however this does not exclude conduction failure at the root level. Velocities remain satisfactory. On EMG reduced recruitment with some reinnervation seen in both upper & lower distal muscles.. Sparse fibrillation in the upper limb.

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

Denervation and can be due to a variety of conditions so is quite non-specific so it's not clear to me how ALS was diagnosed. I do not have all your information so I cannot give you a clinical diagnosis over the internet

Early onset or 'juvenile' ALS occurs but is very rare. It is a progressive disease and should not improve over time. There should be no sensory abnormalities so I'm not sure what is meant by 'sensroy findings'. Other conditions can mimic ALS such as multifocal motor neuropathy with conduction block (which is why they were looking for this), a cervical cord problem or compression, MS, other causes of spinal cord inflammation or damage.

ALS is a serious illness to be diagnosed with, so if there is any doubt you should seek another opinion, perhaps at an ALS Center (the Cleveland Clinic is one) where ALS and its mimics are diagnosed with experience/frequency

[motheroftwo]

Here are my results, minus the sensory test. I hope the text layout is readable after i post.

results:

Motor study (cmap)-
               Dist(mV) Prox(mV) DML(mS)  F LAT(mS)  VEL(m/sec)
Rulnar(SE.ADM)  1.4       1.2      3.1    ABSENT      63
Erb's                     1.3      13.5  
Ll Ulnar        2.6       2.3      3.2    ABSENT      81
Erb'S                     2.4      13.0
R Deep peroneal 1.2                5.4
(SE EDB)    
R Post tibial   13.4               5.4      52.6
(SE AH)            


EMG (CNE)

Muscle   Spontaneous   recruit    Max MUP     other
         activity      pattern    amp (mV)    comments
R TA       NIL         REDUCED      3.0        occ c
L TA       NIL         REDUCED      2.0
R FDI     Sparse fibs  REDUCED      0.5         c

[motheroftwo]

Sorry the first layout didn't work,i have tried again using lines to separate the text hopefully it should work, if it doesn't please ignore it. regards

emg.

results:

Motor study (cmap)-
_______________Dist(mV)_Prox(mV)_DML(mS)_F LAT(mS)_VELO(m/sec)___
Rulnar(SE.ADM)__1.4______1.2_____3.1______ABSENT_____63__________
Erb's____________________1.3_____13.5  
Ll Ulnar________2.6______2.3_____3.2______ABSENT_____81__________
Erb'S____________________2.4_____13.0
R Deep peroneal_1.2______________5.4_____________________________
(SE EDB)    
R Post tibial___13.______________5.4_______52.6__________________
(SE AH)            

EMG (CNE)

Muscle____Spontaneous___recruit___Max MUP___other________________
___________activity_____pattern___amp (mV)__comments_____________
R TA________NIL_________REDUCED____3.0_______occ c_______________
L TA________NIL_________REDUCED____2.0___________________________
R FDI_____Sparse fibs___REDUCED____0.5_________c_________________

[motheroftwo]

Forgot to add: My last emg 2002 showed some fibs & crdsl in the L TA. 2005 emg showed no spontaneous activity in the L TA.