questions

[tania again, add to question]

I would like to have some questions cleared up please. I have bowsed the archives thinking I would find my answers there but instead, I just found more questions. 1)Twice people asked how soon an emg could detect als abnormalities, and once a dr. answered soon, often before the twitches appear because the machine is very sensitive.  But, then I found a question where someone asked the same thing and had an emg only a few weeks after the twitching began, and the dr. said the emg might have been too soon to tell. Is this true or does it pick up things as soon as the twitching begins? 2)Have there been cases where the emg missed it the first time because it was too early?  3)Also, I read that widespread twitching is a diagnostic sign, but then i read that it usually begins with twitching in one place.  What's the answer to that?  Also, I read that eye twitching is not a sign, but then, I read posts where people say there eye's twitch, and the dr. doesn't rule out als. 4)Do eyes twitch with als or no?  Please help clear up these questions, and on a personal note,5) I have twitched for a year. I have no known muscle loss, but I do have eye twitches and twitches everywhere else.  Sometimes my muscles ache and they do cramp sometimes. I sometimes feel as if when I wake up, my muscles are lightly shaking or rocking back and forth. Is this a sign of als? 6) What about some sudden jerks of a whole leg or arm?  I had an emg about four weeks after the twitching began and it was neg. but with the confusing posts, I haven't been able to eliminate the fear entirely. I also had a physical examine 5 months after it all began and it was normal. Now, I am doing the same thing a year later. Please help answer these questions. I am sorry there are so many but some of the above my eliminate future questions of the sort.

[TxLefty]

Just curious- in the absence of new symptoms should an EMG be repeated periodically?  I have PLS- should an EMG be repeated periodically and if so when?

[CCF Neuro[P]-M.D.-RPS]

Dear Monster:

I cannot answer many of the questions your propose because I do not have all the information contained in the questions.  The EMG should find abnormalities, IF present, when muscle fasciculations are pathological.  This is because, fasciculations only occur late in pathological diseases and therefore the process should and is always present by the time they appear. I have never seen a report where the EMG has been normal and the patient has ALS. This would not be the case in benign fasciculations because they do not occur due to observed abnormal pathology.  Eye twitches are not classic for muscle diseases inducing muscle fasciculations.  The vast majority of the time they are isolated are represent other processess.  Where did you read that fasciculations are anything but part of the disease and can be manifest anywhere that is part of the disease, therefore most presentations are possible.  If you read a report that fasciculations always start or always have a presentation, then I would not believe it.  Since it is the end product of a disease, it can be found in a variety of ways depending on the disease.  

You do not have ALS.

Sincerely,

CCF Neuro MD