EMG Results?

[curtis]

Hello Doctor:

I am a 38 year old male who has been having some disturbing symptoms over the last nine months.  I began having fasciculations over most of my body in May of 1999 but they seemed to mostly be in my calves and feet.  In June my neurologist and I noticed some mild atrophy of my right foot.  An EMG was normal except for a slightly slowed velocity of my right tibial nerve (40.6 vs a normal of >41).  All amplitudes were normal.  In October I began having a strange "dull" sensation in my left arm and things also began feeling heavier in that arm.  In November I had another EMG on that arm which was normal.  The sensation soon went away but the "weakness" and fasiculations  remained.  In January, the sensation returned along with some mild transiant dexterity problems in my left hand.  I just recently had another EMG which unfortunatlly showed a rather dramatic drop of amplitude of my left median nerve (13 down to 4). The signal was also "dispersed".  The needle exam was normal (including no fibs or fasics) except for some mild "myopathic changes" in my left deltoid and flexor carpi ulnaris muscles (decreased size, duration; increased frequency). By the way, my right tibial nerve was normal.

I am somewhat concerned about ALS. My grandfather died of it while he was in his late fifties.  Two seperate neurologist do not think I have ALS but cannot give me an explanation for my problems.

My questions are as follows:

1. What can cause a quick and dramatic drop of amplitude and can you experience fasiculations and weakness before anything bad shows up on an EMG (such as a drop in amplitude)?

2.  Can you have atrophy and still have a normal EMG?

3.  Can famial ALS miss one generation and then hit the next?

4.  If you have a low amplitude that is causing weakness and fasiculations, shouldn't something be seen on the needle exam?

5.  If you are having weakness and fasiculations due to ALS, shouldn't you also be seeing fibulations or do they tend to appear later?

Thank you very much for this great service and I look forward to your response.

Curtis

[CCF Neuro[P] MD, RPS]

Dear Dave:

Hang-in there and just avoid the knock out punch.  By the way, go to Stans donut shop by UCLA, if I remember correctly they are excellent.  Stick you toes in the Pacific for me.

CCF Neuro MD

[dave]

Hey Doc,(I mean no disrespect) my fasiculations are constant and seem to be slowly spreading up the backs of my legs and some are getting a lot more 'bounce' to them.Now noticing them in my left hand near the thumb. As things progress is this the usual? Do they increase, decrease or what? As I said I have no visable atrophy, so I'm not sure what to expect.
Has anyone else tried 'Strip Twitching' with their partners? The one who doesn't guess the closest to the next twitch has to...well you get the drift. My wife loses a lot now; I've been watching for some patterns. It's actually fun. Maybe Milton-Bradley could fund it....
Yes...Santa Monica. It was beautiful there today. UCLA Med Center is where I go for ALSA support group. Come back and visit; Loretta (the organizer) brings good donuts and coffee. Fantastic and caring people. I go to those and realize blessings.
By the way...Thank You for this 'forum.'

[CCF Neuro[P] MD, RPS]

Thanks for the comments.  I lived on 7th Street in Santa Monica when I was at UCLA for 5 years.  I do miss the sun and mexican food.  

CCF Neuro MD

[KMH]

Thanks for the reply.. Should have known your fron SO CAL...  I lived in HB for three years and used to sell in Santa Monica.  I'll tell you even on your worst sales day life was still good in Santa Monica.  Good Luck Friend.

[dave]

It's a long story, but I was being evaluated by Othopedic Surgeon for neck and back injuries on the job for a Workers Comp thing when after treating me for about a year, he did some extra detailed reflex checks because of hyper reflexes in knees and such. That's when he found the clonus and suggested I follow up with my regular insurance Doc. When the company and all the lawyers heard about possible neuro problems, everybody scrambled to cover their Butts. So needless to say I got a lot of 2nd and 5th opinions and referrals and great care. The weakness (mild, but very bothersome) was mainly on my left side, and really didn't start until 47. My wife found the fasiculations in my calves and feet which put the docs in the direction of ALS. All of my other symptoms are mild, but I do notice changes. The one that really pisses me off is constantly tripping over my left foot and scuffing my 'NuBucks' on the Santa Monica Pier.
When I got the diagnosis, I went out and got the sports car I've wanted for 10 years, and decided then if I'm going out, I'm going out with the top down and the CD's loud.
I've been around children with Cerebal Palsey for many years. They are my inspiration in any tough time, which I really don't feel I'm having yet. I'm a coward with pain, though.
And the Big Guy rides with me. Thanks

[KMH]

Dave your sense of humor an attitude towards this challenge is to be commended.  Did you come to the neuro you spoke of with weakness?  Why did your first neuro refer you elsewhere?  Just curious. Will send up a word to the big guy in your name.  Keep fighting, never quit.