Very scared - Help me to understand this EMG result

Question

Hi – 

I am confused and scared by the "conclusion" of the neuro conducting my EMG.

The 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 weeks ago. Two 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 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 “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. Or are fasciculations only "fasciculations" (and not merely twitches) when they are not benign?

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 that fasciculations and denervation that might have made things 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 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 anxiety level could explain these. (I am currently being treated for anxiety and depression ).

Can anyone make sense of all this for me?

gohalo83 · Answer

Any Word on your diagnosis? I have very similar symptoms. Lump in throat feeling, extreme GERD and pain swallowing even liquids, and left hand numb/can't spread fingers/and muscle atrophy. Any news on your end? Please.

lovewolf · Answer

I have some muscle tightness - arms and legs. Plus, the softer right calf that feels tired a lot more quickly than the left one, but does not seem to be significantly weaker, strength-wise.

I have another EMG scheduled for early January. I see me GP next week and hopeully she will have the first EMG report by then.

cardiactec · Answer

If your symptoms continue, I'd suggest getting another EMG. Is this what your doctor is planning to do? I'd also get a copy of the report. 

Yes, I do get a lump in the throat feeling. 

Do you have any other symptoms other than twitching and occasional odd swallowing/throat problems?

lovewolf · Answer

My EMG was done about 2 months into symptoms.
Report is due in a week or so.

Do you get the feeling of a lump in your throat?

cardiactec · Answer

It feels like fluids and solids go up instead of down.... Really odd and painful feeling really.... It doesn't happen every day but lately quite a bit. Chewing is an issue, it feels like my jaw is super tight and spastic. 

Currently I'm being checked for MS but I just have a horrid feeling about all of this in general. 

How long after your symptoms started did they do your EMG? Do you have the actual report?

lovewolf · Answer

I am totally with you on the chicken/egg thing!

Thanks for the info. However, that doesn't explain why he would refuse to say the EMG was "normal". 

I've heard ALS is only associated with liquid swallowing difficulty. Does it feel like you have to gulp at everything more than once? What do the chewing problems feel like?

cardiactec · Answer

Hi - 

Recently I have become more anxious because of my symptoms, but i'm not sure if my symptoms are causing the anxiety or if anxiety has caused my symptoms. chicken or egg game ..... 

My swallowing can be good some days and horrible other days .... sometimes it's both liquids and solids I have trouble with, but some days don't bother me much ....

fasciculations, if they are picked up by EMG, do not render the emg abnormal unless there are other findings with the fasciculations to suggest a myopathic (muscle) or neuropathic (nerve) disease. That is why if they tell you benign fasciculation syndrome, it means they saw no other abnormality with the fasciculation to suggest a disease process to cause the fasciculation. In my case, they saw no fasciculations on my EMG (even though I have them pretty much throughout the day) but saw signs of denervation and reinnervation (which they haven't specified or told me the root cause of yet -- honestly, because I think they don't know yet! LOL) .....

How long after your twitching started did you have your EMG?

Hang in there. I know this is scary but keep strong and I will be praying for you as well. Also, an anti-anxiety med, if you're not already on one, has helped me not focus on my symptoms as much, whether or not the egg came before the chicken. :o)

lovewolf · Answer

Thanks for the response.

Sorry, likewise, to hear about your trials and tribulations with this scariest of medical scares.

Are you anxious, like me? I just wonder because when I am in state of high anxiety I find myself at least perceiving swallowing difficulties. Then, the next day I might not even think about it - usually because I am off worrying about a different part of my anatomy! Do the swallowing/chewing problems come and go in this way? What form do they take?

What i meant to say about fasciculations is this: even if we are already aware of their presence (benign or not), do they automatically render the EMG "abnormal" if picked up by it?

Thanks for the encouraging words. You would be very young to get ALS so I would think it highly unlikely in your particular case. For my own part, I will keep praying.

BTW, even though my right calf has lost tone and definition, I do not perceive any significant weakness in it. I have read that even a little muscle wasting in ALS is usually accompanied by debilitating weakness. Do you know anything about that?

cardiactec · Answer

Sorry you're going through this. 

I started having muscle twitching mainly on my left arm and left leg with some muscle stiffness which started in June. They did an emg then, a month into symptoms, and it was normal. 

They just repeated my emg (two months after the first and 4 months after sx started) and it is now showing mild denervation in my left arm and left leg. I now have swallowing and chewing difficulty and some weakness in my thighs. The neuro is not saying one way or another why he thinks I have nerve damage now where two months ago I had NONE. 

I have read that if emg is done early, it can miss certain characteristics typically seen of motor neuron disease, or specifically ALS. I have also read by some that emg would pick up abnormalities before we would even be aware of Symptoms. 

Go with your gut, if your symptoms don't improve or you start having swallowing/chewing problems, voice changes, slurred speech repeat emg is recommended. 

I honestly don't think emgs are that useful until a patient is well under way with symptoms (like at least 6+ months in) as it takes time for denervation to show up on emg. 

I'm still praying I don't have ALS. I am only 28.... But my second emg showing changes after the first one performed two months before the second was normal. :0/

Hang in there. ALS is pretty rare so chances of either one of us having it our slim to none. 

Btw you don't have to see fasciculations on emg to rule in or rule out ALS. I never had one single twitch occur while they performed my emgs.