History of Fasciculations: 2.5 Months

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StevenKane

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First, some background...1) fasciculations started occuring about 2.5 months ago. they first appeared in my right foot (arch/instep) and have since spread to both feet and calves (pretty constant) as well as episodic fasiculations in the buttocks, tricep, shoulder, hands.2) onset of fasciculations followed a very stressful situation for me where i suffered a severe disc herniation that kept me immobilized for several months. then, started on physical therapy and cardio exercise, at which point the fasciculations commenced.3) at the same time the fasciculations started, i got my orthopedic (back) doc to refer me to a neuroligst as i was experiencing nerve-related stuff in my back but also some numbness in my left hand. the neuro did a clinical exam and ran tests to check for MS (MRI scans of brain and neck, which were negative) and an EMG to see if there was something going on with the ulnar nerve. when i went in for the EMG, i told him that i just started experiencing the fasciculations. The EMG report results are below. The neurologist said "you are not showing evidence of ALS, but i cannot rule it out...come back in a few months"Two questions:1) is this considered a clean EMG report (see below)? the reason i ask is that the report mentions fasciculations and i thought i read somewhere that benign fascics do not show up on an EMG report. And, the report mentions that denervation is seen (but, the report also says that no "active" denervation is seen). i am hoping this latter statement is the more relevant.EMG Report (May 7, 2008)EMG of the upper left extremity shows a few fasciculations in the left abductor digiti minimi muscle.EMG of both lower extremities shows a few fasciculations in the gastrocnemius muscles bilaterally and in the left abductor hallucis muscle. There was also chronic denervation i the iliopsoas, quadriceps, tibialis anterior, peroneus longus and gastrocnemius muscles bilaterally, left worse than right. No active denervation is seen.Nerve conduction study shows borderline left ulnar motor conduction across the cubital tunnel. This could be within normal or might suggest a very mild irritation to the left ulnar nerve.There was mild chronic denervation in the L4, L5 and S1 nerve root distribution bilaterally, left slightly worse than right and especially at the L5 nerve root.There were sporadic fasciculations seen in the lower extremities and in the left upper extremity, mainly in the distal muscles. These were not associated with active denervation. These could be part of the lumbar radiculopathy or they could be benign fasciculations. Follow up study in 3 months is recommended.2) i also made the mistake of googling whether fasciculations can precede the onset of weakness and atrophy and be and early sign ALS. Everything i have seen (particularly from posts from Aaron) lead me to believe that there must be weakness identified first (or at least at the same time). one of my concerns is that i have not been experiencing fascis for a very long time (2.5 months). see this excerpt from a Neurology journal article below, which concerns me....Neurology. 2004 Aug 24; 63(4): 721-3de Carvalho M, Swash MFasciculation and cramps without weakness or muscle atrophy are recognized as a benign syndrome. The authors report a patient with cramp and fasciculation, which persisted for 1 year without abnormal motor unit morphology on EMG before progressive weakness, muscle atrophy, and EMG abnormalities developed. This observation raises the possibility that lower motor neuron hyperexcitability may precede motor neuron death in motor neuron disease.i don't want to create any anxiety in anyone, i just want help in reducing the anxiety i am feeling.thank you
 
Hmmmmmmmmm, I dont even want to touch this one. Honestly. I dont understand the EMG report to be quite honest.I do see it shows that your denervation is "not active" which is a good thing. Another good thing is... "he said (your neuro) does not see any evidence of als" however contradicts himself a bit for what ever reason. Maybe a COVER YOUR **** reason.As far as the Hyperexitability leading to ALS I dont think so. I tend to stay away from things like that- but I think that has been mentioned here before. However if you go to THIS WEBSITE right here . It states a few TIMES that a EMG picks up ABNORMALITIES FOUND in ALS even BEFORE FASICS ARE FOUND. Then however once fascics are FOUND and there are no more abnormalities THEN IT IS NOT ALS as well. That one statement you pulled out of wherever about the patient that had a NORMAL EMG I do BELIEVE failed his clinical EXAMS. (could be a different case).I hope someone else will chime in on this one. My EMG was a little more clearer than yours with a little more certainity and states NO signs of MOTOR NEURON DISEASE which includes ALS. Only my neuro herself said "this is NOT als".I think your doc left open that .001% for that .0001% RARE occasion. The important part of that WHOLE EMG is NO PSW's, NO FIBS etc. Did he not give you a reason to WHY he could NOT rule ALS?I dont understand- You've been fasciculating already and it was seen. PERIOD.By the way- BENIGN FASICULATION SYNDROME is FASCICULATIONS WHICH ARE BENIGN! They show up on EMG's it means nothing in isolation. Please take the time to go to the site I provided. Again, I hope someone will chime in. This is a little off kill from what I have gathered, heard and read.Lovely
 
Hi,Search my previous posts and you will see that I had an EMG which showed signs of chronic denervation and polyphasic MUPs in lower extremities.. :eek: I was so scared and have been to 5 different neuros for my report..Just one of them told me that she could not rule out **S but others had a lot of fun with my concerns..I asked if it was **S and if I needed another EMG..Just told me 'NO' and to come back in a few months..The most important thing is to learn what your neuro exactly thinks about your EMG, so I would seek for a more precise explanation. You do not get **S just by having nasties n your EMG..To let you know, after 5 months in which I had many ups and downs I am doing so much better now..I could barely lift my left foot at times (the one which showed slightly increased chronic denervation) but now it is completely gone..I was even sypmtom free for a few weeks ago.. :) And now I am having extreme numbness in my legs, feet and my left hand..Last night I could not even sleep for just a minute because of the numbness-burning and tingling in my feet. Especially toes. :mad: What I know is, if it was ALS I could not heal completely and then start to experience these things again..In 5 months I would be in a wheelchair. I still do not have any real weakness..I don't know what to blame now but I will not torture myself anymore by thinking about **S. Also, I won't go for an EMG again unless I show any signs of real weakness. ;) Ease your mind..It could be anything..Theo,
 
Hi,Search my previous posts and you will see that I had an EMG which showed signs of chronic denervation and polyphasic MUPs in lower extremities.. :eek: I was so scared and have been to 5 different neuros for my report..Just one of them told me that she could not rule out **S but others had a lot of fun with my concerns..I asked if it was **S and if I needed another EMG..Just told me 'NO' and to come back in a few months..The most important thing is to learn what your neuro exactly thinks about your EMG, so I would seek for a more precise explanation. You do not get **S just by having nasties n your EMG..To let you know, after 5 months in which I had many ups and downs I am doing so much better now..I could barely lift my left foot at times (the one which showed slightly increased chronic denervation) but now it is completely gone..I was even sypmtom free for a few weeks ago.. :) And now I am having extreme numbness in my legs, feet and my left hand..Last night I could not even sleep for just a minute because of the numbness-burning and tingling in my feet. Especially toes. :mad: What I know is, if it was ALS I could not heal completely and then start to experience these things again..In 5 months I would be in a wheelchair. I still do not have any real weakness..I don't know what to blame now but I will not torture myself anymore by thinking about **S. Also, I won't go for an EMG again unless I show any signs of real weakness. ;) Ease your mind..It could be anything..Theo,
 
Lovely and theo, thanks for both of your responses. i also got a very helpful (and reassuring) private response from Alonzo, which i have copied and pasted below. this is consistent with what i heard from the neuro (although he could have been more clear instead of covering his a**....my EMG is not a "clean" EMG, but the denervation is not associated with ALS....it's likely the result of my history of back problems, including multiple herniated discs. And, Theo, i agree with you. in the absence of weakness i don't plan on going back to the neuro. i think the reality is that i don't cope with stress/anxiety well...and, i had a tough time with my most recent disc herniation which let to a lot of anxiety which in turn has caused fasciculations, which in turn has caused more anxiety and so on, and so on.i am going to move on and get back to living my life. thanks, stevenFrom Alonzo....It says it pretty clearly in three places:"No active denervation is seen.""These were not associated with active denervation.""These could be part of the lumbar radiculopathy or they could be benign fasciculations.""lumbar radiculopathy " definitions: 1) Lumbar radiculopathy means that you have leg pain as a result of a nerve problem in your lower back. 2) Lumbar radiculopathy: Nerve irritation caused by damage to the discs between the vertebrae.3) Lumbar Radiculopathy. Herniated disc, 90% at L4-L5 & L5-S1, which nerve root is affected depends on whether the disc herniation is central or lateral NONE of wich have anything even remotely to do with ALS or CURRENT or ACTIVE denervation. You may however have some old back injuries (a car accident, a bike accident, falling off a skateboard as a kid, lifting things too heavy for your body, etc.), which is why "things" such as Lumbar radiculopathy are showing up, but it ain't ALS. There is a HUGE difference between old injuries and ACTIVE denervation caused by a disease such as ALS. Again, this is why not everyone normal has a clean EMG. People don't take these facts into consideration. The fact of the matter is, just like old cars that wear out a little as they age, so do our bodies, and that sort of stuff shows up on EMG's, but it doesn't mean it has ANYTHING to do with ALS what so ever.Quit trying to find something that ain't there. That is 90% of the battle with BFS... BELIEVING what your doctors say and what the FACTS say. The facts are no ALS... period.Alonzo
 
Responding to your second item:Also I had some ortho issues - not too different from yours. Basically, I started getting muscle pulls, strains, etc. from what I was then told were just 'tight' muscles. ("Hey, you need to learn to RELAX", or my favorite "You're not getting any younger.") I had never had tense muscles before even though I've been physically active all my life. The ortho guy said I was 'curious' which may have been another way of saying 'nuts' (reading his body language as he moved away and lifted just one eyebrow). Finally, stabbing pains in my back got me to the neuro, who diagnosed me with CFS/BFS and low and behold, the spasms had squashed 2 of my discs and they were leaking onto my nerves causing much pain. It took a long time to heal BUT now I know how to deal with this better and haven't had anymore ortho trips - relaxation techniques, knowing when to stop and let the muscles un-clamp, etc. etc. I have also found that some things that I eat and drink can set off my CFS (as have many on this forum, i.e. caffeine and sugar) within a few hours so I avoid them. The worst of these is any dark spirits, including wine and most beer (Google 'congeners' and draw your own conclusions about this) - which I am told affect many of those affected with this syndrome. Anybody here seen this connection?About your EMG report - you should bug your neuro about this and make him explain everything he says. He is, after all, getting paid to be your health professional. Don't let him off so easy. My neuro enjoys talking to me about this stuff but maybe its because I am, at least, one patient he has that doesn't have a fatal disease so he can be more jovial with me.
 

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