Fasciculation: Visible Movement?

[GinniferLynne]

Slavin,

I'm not talking about malignant vs benign. I think you may have misunderstood my question. I am talking that the defnition of fasciculation is visible movement beneath the skin. If you can feel them, but not see them, does this make them TRUE fascics?

Ginny

 

[SlavinBreeze]

It doesn't matter if fasciculations are visible or not. Only EMNG by good engineer (or doctor) WHO IS INTERPRETER also (EMNG is more subjective then objective method) is reliable exam. Clean EMNG means NO NMD OR ANY OTHER DESEASE. Do your own EMNG and after few days or 1-2 week another one by another doctor at different location. After that do not think about ALS in next 10 years! I'm working on very popular radio station here in Croatia. At least 5 people from the station told me about their twitching in last 20 months. Of course no one has any terminal desease like ALS. They are all very sugestible and heard about NMD from me for the first time. Even my Neurologist has eyelid twitching!
Slavin

 

[GinniferLynne]

Slavin,

Thanks for your reply, but doesn't totally answer my question -- but thank you for trying! )

Bill,

I laughed my @ss off at your reply - probably because it rings of truth!!!

Ginny

 

[ranpaumme]

I think some of the ideas mentioned in this thread are misleading, but perhaps not intentionally (there may be some translational/cultural differences). From all I have read and heard from experts over my own extensive investigations over the last year, there are only fasciculations and the idea of benign vs. malignant fascics is not really a valid theory. Some may disagree, but at least in North America, a fasciculation has a characteristic EMG signature and there is no way of knowing if it is a benign or physiologic phenomenon or part of a disease state per se. It is the "company they keep" that is the key to the presence or absence of disease, ie. fibrillations, positive sharp waves, multiphasic motor unit potentials, abnormal recruitment/interference patterns, etc. And even some normal people have some of these. See the teleemg.org site for more info about this. If a muscle fascicle is close to the skin and it twitches, you may see it, if it is deep in the muscle you may not see it and you may or may not feel it. Not all fasics are perceptible. I get the implication in this thread that if an EMG finds a "true" fasciculation this is considered "malignant", and if it finds nothing, ie clean, everything is OK.
I believe this is wrong, the whole concept of BFS is that people may have more fascics than a person without the syndrome, but it is benign anyway.
Maybe the Euro. translation of benign vs. malignant means something different, but to me it sounds like benign vs. MND and I don't believe this, and could cause a lot of anxiety for many of us that have "true" fasciculations, some of which we don't feel, proven on EMG, and have no indication of any serious disease. I know there are some authorities that
claim the morphology of the EMG signal of a fascic may sometimes point to a disease state like MND(ALS) but I think this is becoming passe as more and more is learned about BFS/peripheral nerve hyperexcitability and just plain normal variation. So please stop with the benign vs. malignant language, it's scaring even me!

 

[miguel4life]

FWIW, I agree 100% with what you are saying aremm. Fascics by themselves pretty much mean nothing. If you get an EMG that detects "true fascics" and nothing else, your neuro will consider that a clean EMG. It is the other things you mention that can be more troubling, but even those are not conclusive by themselves.

Again, the true hallmark of ALS is clinical weakness. If an EMG documents those other items, AND it is combined with clinical weakness on examination, the doctor may classify you as "possible ALS" or maybe even "probable ALS". Even this is not definitve though. Other tests are still needed to provide confirmation as well.

Also, as you mention, some people have "dirty" EMG readings but are still completely healthy. One neuro that tested my dad said he gave himself an EMG when he first started using them, and it was dirty. He said it scared him to death, but that nothing ever developed even after 12 years.

Finally, many neuros will tell you that perhaps the most important diagnostic tool they have is time. If you are not experiencing clinical weakness that is getting progressively worse over time, then the likelihood that you have ALS is very, very remote -- even if your EMG shows some abnormal findings.

Let me stress that almost all (if not all) of us are not even remotely close to going down that path, and we NEVER will be. No sense stressing out over something that in all likelihood will never be relevant to any of us IMHO.