Diagnos?

[victor11]

Hello

I have continous fascikulations in both calves since november 2009.Also had numbness and tingling in feet, Dr said it was nerv entrapment. Right arm and fingers got stiff short after, and muscle in thighs and arms got easily sore. In february some atrophy showed in left hand, and numbness and tingling sensations in fingers, that still come night time. Most numbness now.
Neurologist didn´t notice Als-finding ( no clinical weakness)  march 2, but send me for EMG.
From march I now also notice more widespread fascikulations ( in thighs, arms, back , feet etc)  though they only last ca 10 seconds  each time.
Right leg show signs for easy exhaustion when walking more than 20 min.
I now have atrophy in both hands ( interiossous muscles), and right wrist feels weak, Embarass me when I lift heavy or turn hand in awkward position( get card from wallet etc).  Also some atrophy in right calf ( cavity under tibia), and also right buttock is visible smaller than left, and I get hurt when sitting in a  hard chair.
Joints in thumbs and wrist crack all the time.

I had EMG/ENG april 6.
Neurologist interpreted EMG. He noticed some findings in right leg, but said they were chronical  and probably came from back problem. He didn´t notice general findings that would suspect als. He had no explanation for atrophy, and closed contact.I asked him for diagnos, but he had nothing to say. Send me back to prime doctor.
I still worry a lot. Beside having actual growing physical problems, all the worrying interfere with my work performance.

1. Would you say it is possible to have Als without clear EMG- finding in this stage ? For example, by the time I had EMG done april 6 , I already had atrophy in both hands and buttock, but then no weak wrist. Not many fascikulations in arms though.
They checked both arms, right leg, and back. They didn´t check left leg.

2. Would you suggest any alternative diagnosis possible?

I would be most greatful for getting answers, and other of your thoughts.
It seems to me that in Sweden ( my country) neurology is not priority number one , and they do not have much time for patients.

[Dr. A. Srivastava]

Thank you for your question. If there is denervation in extremities, they can become atrophic and their EMG response will be poor. However, it is very difficult to diagnosis ALS (amyotropic lateral sclerosis) because it has similar symptoms of muscle weakness and atropthy that other neurological disorders also can have. However, combination of tests like EMG and NCV (nerve conduction velocity) may help in finding the diagnosis. Additionally, ruling out other neurological disorders with MRI may help you to reach at appropriate diagnosis. I would recommend that you consult a neurologist right away for more precise opinion. Hope this helps.

[victor11]

Would you please comment my question of EMG. Is it , in your experience, possible to have early ALS without findings in arm? When I had atrophy in hands at time for EMG.
And also he noticed discrete denervation in leg. Wouldn´t chronic disturbance from back, give large amplitudes, not "discrete"?

[Dr. A. Srivastava]

Thank you for your question. There can be several reasons of such symptom although without being able to examine you I can not offer you the specific advice on diagnosis and treatment that you need, but I would try to provide you some relevant information about your health concern.

This muscle spasm is also called as muscle fasciculation & appears when the muscle contracts on its own (without nerve stimulation).  However, sometimes this muscle twitching appears as atrophy and weakness of muscle as well. Most likely cause of this twitching with weakness or atrophy of muscle can be when the nerve supplying to muscles are not functioning properly due to any neurological disorder. If you suffer continuous weakness and notice reduced strength of muscle bulk in areas, please arrange an appointment with a neurologist right away who will evaluate the possibilities here. Hope this information proves helpful to you. Take Care & Regards!!!