Resilientgirl
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Status: We're Waiting For YouCategory: NeurologyUnfollowValue: $38SMS Text AlertsAsked by you on Sunday, September 01, 2013 8:41 PM EST1 Answered Question Hello ,It all started after a medication pill I took for harder erection. I was not suffering any ED but I tried it for curiosity. It was purchased from a gas station I know it was very bad idea. The night I took That pills I had the worst panic attack. My heart was beating fast I ran to ER got an EKG along with troponin blood work everything came back normal. This has not stopped here I kept having panic attacks for another 6 months then it went away and my fasciculation has started all over with muscle pain excercise intolerance. I have seen 4 different neuro with 5 emg done at different time interval but no degeneration and I don't have weakness I have done all kind of blood work Ana , lupus , Lyme everything was ok but my testosterone was low I was out on clomid. Now After almost 1 year of symptom I m still not confident That my only diagnosis is bfs. I m having weird symptoms both of my thighs and legs. Feel stiff and I feel it's going to give up when walking but no weakness. It feels heavy. Could this be an autoimmune disease I was tested negative to ANA sed rate and creatinine. I m very lost. What do you recommend to whom I should speak. My symptom is real. I don't think neurologist can help me anymore. Nor another emg. Whom I have to speak regarding an autoimmune disorder. WhSt blood work is needed to rule if out. Is ANA enough if it was negative but my CRP was 3.6. Normal below than 3 Please help me Optional Information: Person's Gender: MalePerson's Age: 26 You have received an Answer!From neuromd2012Sunday, September 01, 2013 8:56 PM ESTWelcome to Just Answer. I am an Adult Neurologist and was contacted to answer your questionHello. Has anyone discussed Stiff Person Syndrome with you? It has a characteristic EMG abnormality, so if your EMG's were all normal, that pretty much excludes the diagnosis. It is a condition with stiffness that seems linked to emotional distress. It is an autoimmune disorder, the blood test is Anti-GAD antibodies, which are produce.Take a look at this webpage from Yale. This condition is extremely rare, get back to me if you think it fits. Dr Frank TPlease remember to rate my service once you have all the information you need. If you have any other questions, please ask me – I’ll be happy to respond. Thank you! Rate to FinishYOUR RATING IS REQUIRED to determine your Expert's credit for this answer. Unless you rate "OK service" or higher, your Expert will not receive credit.Bad servicePoor serviceOK serviceGood serviceExcellent serviceSelect the face that best describes your Expert's service and click Submit.Or, Reply to Expert You repliedSunday, September 01, 2013 9:08 PM ESTIt does fit my description but my emg were normal Dies a negative ANA rule out all autoimmune disease What is the possibility That what I am suffering is als related. You have received an Answer!From neuromd2012Sunday, September 01, 2013 9:17 PM ESTIncidence of ALS in patient in your age group is greater than 1:200,000 which would make it more likely than SPS, but there is no chance that this is motor neuron disease after this long a period (with the exception of BFS), and 4 normal EMG's. Stiff person is more difficult to diagnose on EMG and you might want to see a neuromuscular subspecialist if you haven't, or just call one of the neurologists that did the EMG's and ask if SPS would fit the EMG that was done. any question, and you need an anti-GAD antibody level drawn. ANA is a screening test. It has both false negatives and false positives. A more specific group of tests is called the ENA, extractible nuclear antigen tests, which include a DS-DNA, anti-Ro, anti-Smith, anti-smooth muscle, SSA/SSB, etc. I will attach a webpage in ENA testing for auto immune diseases. Edited by neuromd2012 on 9/1/2013 at 9:18 PM ESTPlease remember to rate my service once you have all the information you need. If you have any other questions, please ask me – I’ll be happy to respond. Thank you! Rate to FinishYOUR RATING IS REQUIRED to determine your Expert's credit for this answer. Unless you rate "OK service" or higher, your Expert will not receive credit.Bad servicePoor serviceOK serviceGood serviceExcellent serviceSelect the face that best describes your Expert's service and click Submit.Or, Reply to Expert You repliedSunday, September 01, 2013 9:34 PM ESTYou said there is no chance of any motor neuron disease after the long period and 4 emg. Should I stop worrying about als and move on. I Cnt seem to move on because I have heard That some als patient had clean emg to be later diagnosed with als What are my chances to get als. You have rated an Answer!From neuromd2012Sunday, September 01, 2013 9:52 PM ESTyour chances are much less than 1:200,000. You need to move on from ALS, and I expect you have been told that ,and still cannot let it go. I see this everyday in my online practice, if you see my past discussions, there are many from patients that have had a half dozen EMG"s over 2 years or so, and are still not getting the point that they do not have ALS. On EMG, it is not just looking for abnormal fasciculation patterns, it is looking at the motor unit morphology, and changes that commonly occur early on. Try not to listen to what is on the internet, it is not helpful to you.Please remember to rate my service once you have all the information you need. If you have any other questions, please ask me – I’ll be happy to respond. Thank you! You Rated:Excellent service You repliedSunday, September 01, 2013 10:04 PM ESTI promise last question. The last neuro I saw had done an emg and stated That I have no als but he was concerned about SMA. SMA is a type of motor neuron disease but he told me That there was no degeneration and clinically I show no sign for it. Why woukd he recommend a generic testing to rule it out if SMA can be shown clinically abd on emg. After I left his office I went to my other neurologist who examined me gave me another emg and told me Thst I don't have SMA.Would SMA be detected on emg and clinical exam ?Also the other neurologist mentioned That I have lost some muscle fibers due to some disease I had when I was a child. Like polio he said its a finger print. WhSt is your input on That ?Finally , the emg picked up degeneration in my right Detloid but my neurologist told me that anyone will show degeneration in this area less than 25% he was not convened about it. Do you agree ? He picked it up with needle he said this is whSt degeneration sound like but hd told me not to worry because the deltoid muscle is expected to have it. Is this true ? You have received an Answer!From neuromd2012Sunday, September 01, 2013 10:16 PM ESTLet me start with the easiest question. The comments about the Deltoid is true, especially the anterior deltoid muscle commonly shows motor units that have a chronic denervation morphology, which is a normal finding. SMA is primarily a disease of infancy or early childhood, but you can have adult onset forms, is is very rare as well, and shows some EMG changes, specifically large amplitude MUP's and prolonged duration MUP's. It can look like post-polio syndrome, with subtle weakness, but it is an EMG diagnosis, and your CPK enzymes should be mildly elevated. It is an autosomal recessive disorder, so you can have a family history which may be hard to track. SMA is pbrogressive weakness over time, you told me you really have no weakness, just stiffness??? SMA has diminished deep tendon reflexes, so the examination is also helpful in getting a diagnosis. There are companies that do genetic testing for SMA> (test #215)I hope that helps get back to me anytime ok? Dr Frank TPlease remember to rate my service once you have all the information you need. If you have any other questions, please ask me – I’ll be happy to respond. Thank you! Rate to FinishYOUR RATING IS REQUIRED to determine your Expert's credit for this answer. Unless you rate "OK service" or higher, your Expert will not receive credit.Bad servicePoor serviceOK serviceGood serviceExcellent serviceSelect the face that best describes your Expert's service and click Submit.Or, Reply to Expert You repliedSunday, September 01, 2013 10:19 PM ESTThank you Dr. Frank. You are the best You have received an Answer!From neuromd2012Sunday, September 01, 2013 10:21 PM ESTgood luck to youPlease remember to rate my service once you have all the information you need. If you have any other questions, please ask me – I’ll be happy to respond. Thank you!