EMG and ALS

[Lono]

Hello,

First, I should start by saying that I am a 30 year old male with a pervasive fear that I have the beginning stages of ALS.  Part of me realizes that this may simply be hypochondria, but I have had some strange symptoms nonetheless.

My first symptoms started approximately one month ago when I started to feel brief sensations of heat on my upper-left calf.  The sensations were not uncomfortable, and eventually progressed to an intermittent "pins and needles" feeling in my lower leg that was accompanied by a spreading of the heat sensation to my foot.  

I saw my Dr. about this and he ordered an EMG and NCV to be done of my leg.  In the interim, I started to feel some of the pins and needles sensations in my right leg, which was followed by a cramping feeling in my hamstring and sometimes my calf.  

Fast forward a few weeks later, the EMG and NCV came and went without incident... it was performed on both legs beneath the knee and was determined to be completely normal.  I even mentioned to the Dr. my fears regarding ALS, and he laughed them off and said he was "150% sure" that I did not have it.  Later that day, however, after going out for a brisk walk, the muscle above my right knee twitched visibly for about two hours.  After the reassuring EMG, this set me back to some more profound worry about ALS.

So my questions is this: should a normal EMG of my calves and feet reassure me that this is not a case of ALS, even if twitching started later that day above my knee, where the test was not performed?  I have tried researching this on the internet and have found little information, save for one patient of BFS that was told by their neuro that if ALS started in a hand, an EMG of the leg would still turn up mysterious results.

Thank you so much for reading this.  I have another Dr.'s appt. scheduled, but am looking for some reassurance in the interim.

Dave

[DrNavneetMD]

Hello Dear,
A common first symptom  of ALS is a painless weakness in a hand, foot, arm or leg, which occurs in more than half of all cases. Other early symptoms include speech swallowing or walking difficulty.
A person with ALS usually presents with problems in gait resulting from muscle weakness, or with difficulty speaking or swallowing. Sphincter control, sensory function, intellectual ability, and skin integrity are preserved

Usually the first muscles affected are those in the arms and legs. Walking or climbing stairs may be difficult. The patient may drop things, fall, experience muscle cramps, and laugh or cry uncontrollably. The arms and legs may feel especially tired. If the hands are affected, the patient may have difficulty picking up small objects or turning keys. Speech problems, such as slurring, hoarseness, or decreased volume may also occur.
Signs and symptoms include the following:Absence of spinal reflexes,loss of muscle tone, muscle twitching
• Excessive salivation
• Extension of the big toe and abduction of the rest of the toes in response to lightly stroking the sole of the foot
• Reduced muscle tone, or hypotonia, and rigidity
• Hyperactive tendon reflexes
• Impaired speech
• Impaired swallowing
• Rapidly alternating muscle contractions and relaxations
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.
You should get a second opinion and unless these tests are done the disease diagnosis cannot be done.


.Refer http://www.neurologychannel.com/als/index.shtml
http://www.neurologychannel.com/als/symptoms.shtml
Best