als question

can an emg rule out bulbar onset.

can someone have limb onset and bulbar at the same time.

in three months. ive seen three nueros. had an emg after thirty days came back clean. Twitches never have stopped even though i was told they were benign. Have just started noticing lump at bottom of throat along with facial thinning.

Is this possible all in three months. im 37 yrs old. I mean can you have two and a half months of cramping, soreness and twitching and possible atrophy, it looks like i have dents in like six places.this all being below the neck for over a week. Then all of a sudden the soreness and cramps stop below the neck and then it hits your throat and face.

[dr_simran]

Hello Dear,
ALS is difficult to diagnose because the symptoms are similar to those of other neuromuscular disorders, many of which are treatable. The diagnosis is usually based on a complete neurological examination and clinical tests.
The neurological exam usually shows evidence of muscle weakness (localized or widespread, depending on the extent of the disease). The exam also reveals muscle atrophy. The muscles may be so stiff that when the neurologist moves them, they continue to move abnormally afterward. When the neurologist tests the "knee jerk" reaction, the movement is abnormally quick.
Because ALS affects the skeletal, voluntary muscles, the neurological exam does not reveal abnormalities in the sensory reflexes (i.e., vision, hearing, taste, smell, touch, or bowel and bladder control).
Tests
Nerve conduction velocity  and electromyography  help diagnose nerve and muscle disorders.  
As muscles contract, they emit a weak electrical signal that can be detected, amplified, and tracked, providing information about how well the muscles are working. These responses are abnormal in cases of ALS.



Tests may be performed to rule out other neurological disorders. Magnetic resonance imaging may be used to rule out spinal cord disease. Blood tests may be done to detect the presence of heavy metals such as lead in the blood. Laboratory tests may detect abnormal proteins or hormone levels associated with other neurological diseases.
Unless these tests are done the disease diagnosis cannot be done.You should go in for a second opinion. It seems that  possibility of ALS is not there and it could be Benign fasciculation syndrome which is a neurological disorder characterized by twitching of various voluntary muscles in the body like that in eyelids, arms, legs, and feet.The twitching may be occasional or may go on nearly continuously. Beta-blockers and anti-seizure drugs an be taken.. However, often the most effective approach to treatment is to treat any accompanying anxiety.
Refer http://www.neurologychannel.com/als/index.shtml
http://www.neurologychannel.com/als/symptoms.shtml
Best