Emg results regarding twitching and possible ALS

[Mark Anthony]

Hello.  My question doctor is directed towards recent EMG results.  I had my right arm, right leg  (Calf) right ankle,right shoulder tested (emg).  I had normal results in my emg.  However the Nuero did not test my face, tongue, neck area's for fibrillations or denervation.  


my question sir is this?

1.  Would normal EMG test results on the aforementioned areas also include the bulpar area of als.  I am concerned that he didn't do that area.  My neck and tongue do twitch along with lips etc.  Of course everypart of my body seems to have twitched at one time or another.  

2.  In your opinion,  is the probability of a normal emg   result rule out bulpar onset als even if emg wasn't done on the face, tongue etc?  Or should I get another test done?  

Please advise asap.

[CCF Neuro[P] MD, RPS]

Dear Mr. Akt:

Sorry to hear about your fasciculations.  There are pretty strict requirements for EMG diagnosis for ALS.  They include three areas that show definite fasciculations, fibrillations, low amplitudes on conductions studies with a completely normal sensory conduction study.  The areas that are included are bulbar, spinal, limb, and facial.  If the EMG reports says, completely normal exam, you can be pretty sure you do not have ALS.  Often, if the EMGer thinks that ALS is likely but without the absolute criteria, he/she will say "only suggestive of the possibility of ALS or motor disease".  If your neurological exam was normal, then combined with the EMG results, it would be very, very, very, unlikely that you have ALS.  Bulbar ALS is not that frequent and has swallowing and chewing problems in addition to the tongue problems.  There is evident muscle weakness, not only fasciculations and also muscle cramping.  

So, you do not have ALS.

Sincerely,

CCF Neuro MD

[Sandra]

My question sir,or Madam, is this ?

[mgh]

C'mon, Mark, you need to let it go.

[CCF Neuro[P] MD, RPS]

?

[CCF Neuro[P] MD, RPS]

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[Kev ( From Neuroweb) Hi Everyone!]

Thanks CCF Neuro...Now you've got me worried again.I've had twitches since last October in the calves and feet.I've had 3 EMG's which showed fasics only.However my peroneal nerve amplitudes were reduced during the first EMG in Jan. at Mayo clinic and second one showed same reduction. Neuro exams were normal.Thing is, with exercise my legs are getting stronger not weaker so I figured no ALS. Now you go and put reduced amplitudes as a criteria above and I'm getting nervous again.Sooth my mind please.

[CCF Neuro[P] MD, RPS]

Dear Kev:

I wouldn't worry. The decrease in amplitude has to be view within the context of the clinical exam and EMG.  You had a normal neurological exam, the EMG did not show sharp waves or fibrillations.  A decrease in amplitude in only one nerve tested is not diagnostic.  Many things can give a decrease in amplitude.  You do not have ALS.

Sincerely,

CCF Neuro MD

[mig]

I have had muscle fasiculations for the past 3-4 months.They occur everywhere, calves,feet,thighs,abdomen,hands,etc.They initially started in my lower legs and seem to have spread.I had an EMGdone by adoctor of sports medicine in my legs and he told me it was completely normal.He also tested my reflexes and Babinsky,all were normal.This was at least 3 weeks ago,but these fasiculations seem to be getting more pronounced. I do not feel I have developed any specific weakness, but my arms and legs ache alot, this seems worse in the am and gets better as the day goes on.I also have some cramping in my hands and feet, worse in the am when I first wake up.I am a nurse and am scared that this could be ALS. Could an EMG be normal in an individual with fasiculations? I had this test on a day when the fasiculations were pretty quiet. Thanks so much!

[CCF Neuro[P] MD, RPS]

Dear MIG:

See your other posting.  Please only post once as you are affecting the others who want to post their questions.

Sincerely,

CCF Neuro MD