help me to understand this EMG result

Hi –


My EMG was originally ordered due to fasciculations – some of which are experienced intermittently all over ny body, but most of which are evident continuously in my calves. They began six or seven weeks ago. Two or so weeks ago, I noticed that my right calf, though not diminished in size, had lost some definition and become a little flaccid in comparison with the left one.

After the exam, the neuro told me that he wasn’t totally sure, but that he thought BFS was still the correct diagnosis. (My GP had earlier suggested that). He explained that fasciculations were found in the EMG but no denervation – “today” (he worryingly added as an afterthought). I asked him if that meant the EMG was “normal”. He only replied, “I can say that it is consistent with benign fasciculation syndrome.” I asked if the fasciculations themselves appeared benign – because, after all, we both could notice them with our plain eyes, no EMG necessary to see them. He replied that it was difficult to tell. Do fasciculations automatically render an EMG abnormal, or is it only of there are also signs of a disease process?

He has ordered an MRI on my neck to check for compressed spinal cord (as differential diagnosis), and asked me to come back in three months for another EMG.

I am confused. What differentiates a “normal” from an “abnormal” EMG? Is it abnormal if fasciculations are found? What else is looked for other than fasciculations and denervation that might render the result ambiguous? And isn’t an EMG always clear-cut? Can an EMG be simultaneously consistent with BFS and ALS, for example?

I feel his statements were evasive and I fear he was stalling on telling me the worst, particularly as he noted my heightened muscle tone (apart from the right calf, that is) and brisk patella reflex – although he also said my super-high tension level could explain these. (I am currently being treated for anxiety and depression ).

Can someone make sense of this for me?

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

It must be emphasized that in the MAJORITY of cases muscle twitches are benign meaning that they are of no consequence and are not resulting from a serious cause. In such cases, the twitches may be related to anxiety/stress, caffeine, and often occur after recent strenuous activity or muscle over-use. It is important in such cases to reduce stress/anxiety levels and to reduce caffeine intake. Tremors of the hands can be physiological that is exacerbated by stress/anxiety and caffeine.

Benign fasciculation syndrome is a condition in which there are involuntary twitches of various muscle groups, most commonly the legs but also the face, arms, eyes, and tongue. If the diagnosis is confirmed and other causes are excluded, it can be safely said that the likelihood of progression or occurrence of a serious neurologic condition is low.

When BFS is present but not particularly bothersome or disabling, treatment is not necessary. If severe and it requires treatment, there are a few medication options though this condition is not very common, and the research that has been done on its treatment is limited. Minimizing caffeine and stress, and treating anxiety if it is present, will improve your symptoms.

However in general (and please understand I am not trying to imply I feel this is the case in you), when fasciculations occur in the setting of associated symptoms such as progressive loss of sensation, tingling or numbness, weakness, trouble swallowing and other symptoms, the cause may be due to a peripheral nervous system problem. In general the symptoms would not be episodic and triggered by certain things but would be more constant/frequent without consistent triggers. The location of the problem could be the anterior horn cells, the area where the nerves that supply motor innervation to our body comes from. These are the cells that give off the nerves that allow us to voluntarily contract our muscles. The diseases that might affect the anterior horn cells include ALS (also called Lou Gherig's disease), a condition called spinal muscular atrophy, polio-like viruses, west nile virus, and other infections.

Another nervous system problem, neuropathy, may also lead to fasciculations. There will again be associated weakness or sensory changes.

Often these symptoms may reflect emotional/psychiatric problems related to stress (what is called somatization disorder). The latter is a true medical condition whereby instead of a patient experiencing depression or anxiety, they experience physical symptoms, and once the stress is addressed, the symptoms resolve. Fibromyalagia is another medical condition that leads to whole body pains, and is best treated with medications such as lyrica and neurontin, exercise, and physical therapy.

EMG results can vary from person to person depending on training/experience. However, it can localize disorders. I did not perform the EMG and cannot comment further on the results, thus, I suggest you discuss the results further with the physician who performed the test.

Thank you for using the forum, I hope you find this information useful, good luck.