Re: EMG and MND's

Posted By SD on July 26, 1999 at 10:04:08
Hi,
I'm a 28 yr. old male. I've been experiencing widespread, sometimes profuse fasciculations for just over five months. They occur everywhere (save for tongue), but most frequently in the calves/legs.
As for stiffness,cramping, and aching they tend to be most problematic in my right forearm; incidentally, where I first detected the fascics. I've been examined numerous times since this started, with the only remarkable finding being hyperreflexia (2+ in legs). Comprehensive/esoteric bloodwork has been either negative or equivocal with an initially positive ANA of 1:160 which has come down to 1:40 being the only noteworthy finding. I've had 3 EMGs at an MDA clinic at various intervals. The first included NCV. NCV was not repeated b/c neuro said, "...in fact, I've never seen amplitudes like yours." The most recent EMG was just about four months after the first twitches, and showed nothing but insertional irritation in one muscle in the, you guessed it, right forearm. MDA neuro deemed this insignificant. This last EMG was pretty thorough, as I had read El Escorial and insisted on it.
My neuro suggests that I am pretty much in the clear of an insidious pathology, as I would most likely be showing some significant denervation and/or clinical signs on exam by now..."You're not one of the one's I worry about..." Well, I worry about me nonetheless.
Do you folks concur with his opinions as I've summarized them, or should I keep pushing for EMG's and exams every couple of months? I'm not a "tincture of time" kind of guy, and want very much to believe him when he says I'm worrying for naught despite my symptoms.
Your insights are always appreciated. Thank you very much in advance.

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on July 26, 1999 at 12:52:19
Dear SD:
Sorry about your fasciculations, I know that they drive a person crazy.  Not only are they physically irriating but psychologically they are also frustrating.  By the sounds of your EMG and your symptoms, I would agree with your neurologist.  In about 30% of patients with benign fasciculations, have a prior viral upper respiratory tract infection.  The remaining 70% or so we do not know what causes them.  In the vast majority of time, they will persist for varing lengths of time and disappear on their own.  They cause no physical harm and do not have a prognosis of ALS.  Usually, things like fatigue and anxiety will make them worse.  I don't think I would push for continued EMGs unless you like the pain.  Without the accompanied muscle weakness and subsequent atrophy, there is little to worry about.  Also, I would not worry about 2+ reflexes as anxiety will induce these to be somewhat above normal in most people.
Hang in there, as these will hopefully pass in time.  I have them too, and I know what havoic they can render.
Sincerely,
CCF Neuro MD

[was-also-wondering]

Posted By was also wondering on July 26, 1999 at 15:17:44
Is Benign fasciculations typically accompanied with muscle fatigue and/or cramps?  

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on July 27, 1999 at 12:06:33
Dear "was wondering"
Benign fasciculations may be accompanied by cramps and fatigue, but they can exist on their own without any other symptoms.
Sincerely,
CCF Neuro MD

[Thanks-for-your-reply]

Posted By Thanks for your reply on July 27, 1999 at 13:47:34
Thank you for your reply.

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on July 27, 1999 at 17:17:24
You are welcome.
CCF Neuro MD

[LEN__0]

Posted By LEN on July 28, 1999 at 03:45:58
T

[CCF MD]

Posted By CCF MD... on July 28, 1999 at 09:39:06
Good luck

[John__0__0]

Posted By John on July 29, 1999 at 19:16:11
It doesn't really matter what your amplitudes were. Even if they were low a million things from entrapment,damage,pressure, etc could cause that. The EMG is where the money is....without fibrillations, abnormal motor units,etc.there isn't any indication of ALS.Even if you had denervation, still wouldn't mean ALS,again,lots of reasons... Profound weakness is almost always the first indicator....

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on July 31, 1999 at 08:48:06
Dear John:
Thanks for your comments.  If I remember my EMG stuff correctly, one would see fibrillations in ALS.  Late in the disease, as muscle dies it would have fibrillations.  Again, as the muscle dies, the muscle trophic factors would cause axonal loss and this would be seen as slowing with low amplitudes in the needle exam and nerve conduction studies.  
Sincerely,
CCF Neuro MD

[Deborah__0__0]

Posted By Deborah on July 31, 1999 at 23:10:32
My NCS showed low amplitudes across the peroneal nerves...What would cause this, what John said? What else?
Thank you.

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on August 01, 1999 at 17:04:13
Dear Deborah:
Axonal loss.
Sincerely,
CCF Neuro MD

[Lori__0__0]

Posted By Lori on August 02, 1999 at 09:00:05
I have been twitching for a little over a year.  My initial Nerve Conduciton Studt showed a slowed distal latency in the left leg.  Does this have anything to due with amplitude?  I have not had an emg?  Axonal loss as posted above... would this cause slowed latency and what diesease would this be found in?

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on August 02, 1999 at 12:40:03
Dear Lori:
A slowed distal latency can be caused either by axonal loss or demyelination.  The EMG helps in diagnosis but does not usually give the diagnosis.  It usually helps confirm the clinical suspection that arises from the clinical exam and history.  If you do not have muscle weakness, then I would not worry about your twitches, if the other parts of your clinical exam are normal.
Sincerly,
CCF Neuro MD

[Kev__0]

Posted By Kev on August 02, 1999 at 13:06:26
My peroneal nerves showed reduced amplitudes ( 2.1 in left, 5.9 in right, latiencies were normal) and I get twitches in the calves as well....I have had 3 EMG's which showed fasics but otherwise normal.I've had em' for 10 months now and can do more calf raises, resistance,etc. then I could do then, so I doubt I have anything horrible, but I want to know what could cause this.Could the problem be in the back?( My MRI showed mild hypertrophy at L5-S1)Is it a peripheral problem?I'm seeing an Ortho this week because my pelvis is slightly out of alignment ( and after "adjustment's" won't stay in place.I've also had swelling behind both knees for the last month.Is this all related? Thank you for your time.

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on August 05, 1999 at 17:29:24
Dear Kev:
Sorry to hear about your fasciculations.  Likely your back is not involved in your fasciculations.  You would see nerve changes on your EMG and since you don't it isn't your back.  In addition, you would likely have pain and likely parathesias. So, I think your back is not the culprit in this case.
Sincerely,
CCF Neuro MD

[Kev__0]

Posted By Kev on August 05, 1999 at 22:47:23
Thanks for the reply. I don't wan't this thread to go on forever but could you give me some ideas about the peroneal amplitude problems and possible causes.Thank You for your time.
Kev










Follow Ups: