Neurologist Evaluation: Findings

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J

johnsoncarter

Well-known member
Hy Guys,

I was evaluated by my Neurologist today. He was unable to find any fasciculations, because they were not very active when he briefly looked for them. He tested my knee and elbow reflexes, the strength of my arms and legs, had me walk on my toes and heels and in a straight line, follow his finger with my eyes, do squats, squeeze his fingers and tested the sensation on both my feet and legs with a tuning fork and pin. Accoring to the Neurologist the results of this exam was that I was "strong" with no clinical findings or evidence of any neurological impairment or deficits. The Neurologist did acknowledge that I have stenosis BUT did not think it was a major problem because he could not find evidence of any neuromuscular deficits in his exam (this was strange because my right leg has been feeling weak and felt as if it was losing strength daily. However, I guess his test did not reveal any loss of true strength).

In spite of this positive outcome the Neurologist wants me to have an EMG to rule out ***. He stated that the presence of fasciculations needs to be ruled out prior to calling them benign and the EMG was necessary to do so. He noted that many times twitiches are almost imperceptible on patients with ***. He also agreed with me that weakness of the extremity preceded the fasiciculations. He also indicated that the fact that I am having paraesthesias (ie, random shots of pain) was a good sign in my favor. I asked him to be direct with me regarding my chances of having ***. He responded " 2-3%". When I was leaving his office and he noticed that I appeared concerned, he indicated " I am sure that you do not have this disease". Unfortunately I am not as certain as the doctor.

This Neurologist will not be in town this entire week and I have to wait until next week for him to perfom the EMG. I requested if a colleague could perform the exam and he stated that it was not possible. I am not too happy about this because the anticipation is driving me up a wall. I may contact one of the major hosptials in the US (ie, Mayo, John Hopkins, Mass General) to see if I can be evaluated by an *** specialist and have the EMG peformed more expeditiously.

So guys what is your perception of the results of this exam and the doctor's ordering an EMG? Thanks, Carl
 
Thanks for your support and feedback.

In fact, this Neurologist performs his own EMGs in a private office unaffiliated with the major hospital where he is Chief of Neurology.

The question that still lingers in my mind is what percentage of individuals who have a clean Neuro exam are subsequently found to have *** based on the results of an EMG? The fact that I am 60 years old I believe places me at higher risk for this disease than my fellow posters who are primarily in their thirties and forties. BTW, I forgot to note in my original post on this thread that when I inquired of my Neurologist the percentage of false positives on the EMG he responded that they do occur at times. I have seen this occur with some posters on this forum and it is obvious how anxiety provoking such a situation as this would be. Regards, Carl
 
Why is it we won't believe it when a Dr tells us our muscle strength is fine?

I went through all this about three years ago, I went in concerned mostly about my left foot, the neuro said I had no signs of any progressive neurological disease, she did not want to order any tests but agreed to only to set my mind at rest. Being as this is the UK and the NHS I had to wait 9 months for the tests.

The tests revealed "bilateral entrapment neuropathies" in my arms, but nothing worse.

Fasciculations often seem very camera shy. Last night I went to bed with a camera and was determined to film some as I lay on my bed. Guess what, for as long as my camcorder was on and ready to go, no show. I gave up, put the lights out and settled down to sleep. You've guessed, they were back.
 
I basically had the same experience. The first neuro that I saw did an emg which was clean. I followed-up with a second opinion with another neuro then a neuromuscular specialist at an MDA/ALS clinic. He saw the first emg report but still wanted an emg done at their facility. After my appointment I had to take the script down to the electrodiagnostic lab. The script read "Rule Out MND." The second emg showed some fasiculations in both calves. The specialist had me return at the one year point to check strength and reflexes once more before he gave me the all clear. He did not repeat another emg at that time. That's my personal experience.
 
Terri Hill: Carl, I am certainly not trying to encourage you, but I have been down this road before. I can only speak of John Hopkins ALS clinic. You will wait months for an appt, you certainly won't get in sooner than what your neuro has you scheduled for..So don't cancel your current appt.

Carl: I agree Terri. I have rethought the situation and will have my Neurologist conduct this test.

Terri: To get into see the clinic specialists at these ALS clinics is a long wait. Georgetown university hospital has an ALS clinic they seem to be able to get in a little earlier, but even they are a month or two wait.

Carl: Major clinics such as Mayo, John Hopkins and Massachusetts General Hospital may take a very long time to make an appointment.

Terri: Good Luck on your good clinical exam.

Carl: Thank you very much. Your support is greatly appreciated. Carl
 
Carl,

My second emg at the MDA/ALS clinic was more involved than the first one. They tested more areas and left the needle in for a longer time. They use a very thin gauge needle for the test. The puncture into the muscle was not too bad. For me the most painful thing was once the needle is inserted they will move it around to different areas. Then they want you to relax the muscle which I found to be the hardest part of the whole test. Overall it was somewhat painful but not too bad. If I needed another one I would not hesitate because of the amount of pain involved.

Swift_TaySwift20
 
Carl,

In the 2005 edition of Adam & Victor's "Principles of Neurology" the sensations of weakness are very real with BFS or BCFS. In fact if I remember correctly a number of physicians with BFS or BCFS report this sensation of weakness however no weakness is present when tested in a clinical setting.

Swift_TaySwift20
 
Even if your EMG is abnormal there are often valid medical reasons that have nothing to do with motor neuron disease. Old back injuries, compressed discs, etc. can show evidence of both active and positive denervation. Your heavy workouts and passing of the physical neuro tests with no problems would argue heavily against anything like motor neuron disease.

I agree that if the EMG is clean it's a great sign. But if you see activity other than fasciculations on the results it's still no reason to assume the worst.
 
Hi Flatcoat, I hope that my Neurologist who will be administering and interpreting the results of this test will be able to decipher and discriminate between motor neuron disease and "old back injuries, compressed discs, etc"! I don't think that you are intimating that the patient will be expected to interpret the results on their own and drawing their conclusions? Carl
 
Absolutely right Carl. The patient should not be interpreting the results. Your neuro will (or at least should) look at the the EMG and nerve conduction results and interpret them in conjunction with the physical neuro exam results, MRIs, blood tests, etc. In my case it was the disc damage shown in the MRI, along with the normal strength and reflexes seen on a physical exam, that led the EMG specialist to diagnose BFS despite the presence of "very mild" (his term, not mine) active denervation and a "chronic neurogenic process" in all four extremeties.

Best of luck to you on the test. When is the date?
 
I had moderate dull pain in the tops of my thighs and a numbness on the exterior of the leg running from my hip to my ankle. I would also get ocassional sharp pains in my left buttocks. Other key symptoms included dull pain and discomfort in both triceps, which continues to this day.

This is in addition to fasciculations everywhere but the face. I had an initial EMG on both legs and the left arm. The left leg showed two areas of active denervation (defined as being ongoing and/or happening within the last three weeks). Both legs and the left arm showed evidence of chronic denervation.

Because of these results, the neurologist wrote, "These results could be, but are by no means certain, evidence of early motor neuron disease. [Not the words you want to read on a report. Talk about stress!] They could also be due to an ongoing chronic neurogenic process". I was asked to come back for another EMG.

For the second EMG, they did my right arm, the thoracic area of my back, and my tongue (great fun on a slow day!) The right arm showed evidence of chronic denervation, while the tongue and back showed nothing. The tongue and the back being clean were critical, because it removed two of the sites from play that are needed to diagnose ***. My regular neuro felt that there was nothing major wrong with me but suggested that I get a second opinion.

I was then sent to an EMG specialist at the Univ of Penn. He is the guy in Phila who does all of the second EMGs when motor neuron disease or something bad is suspected. He did not do a second EMG, but gave me a full physical exam and reveiwed my EMG, nerve conduction, and MRI records. He said that I had BFS, which I was thrilled to hear. This guy also told me that my active denervation was a "1" on a scale of 0-4, so it was "piddling".

So I guess one of the big differences between me and 95% of the people on this board who have had an EMG is that my EMG was NOT clean, and I was still diagnosed with BFS, as the EMG results were explainable by the 4 compressed nerves in the cervical and lumbar sections of my back.

Hope this helps. Best of luck with your test.
 
Flatcoat,

You have been through some ordeal! To go through these exams and testing with all the anxiety associated with not knowing the outcome can be quite disconcerting. I am very glad you came out of this with a diagnosis of BFS. Regards, Carl
 

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