Should I Be Concerned About Muscular Symptoms?

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BandersnatchF

Well-known member
Should you be concerned about fibrillations, positive sharp waves, and reduced recruitment in your right quad? Yes. Is it definitely ALS or SMA? No. You said that your calf (gastrocnemius) was fine, but you also said that an earlier EMG noted occasional stuff in the same muscle. That doesn't sound like an anterior horn cell disorder, in which muscles don't get better over a two year period. Similarly, ALS and SMA tend to affect distal muscles (further from the spine) before proximal muscles, so it'd be unusual (but not unheard of) for ALS or SMA to affect quads before calf muscles.

Your EMG results are completely consistent with a spinal injury, and fibs and sharp waves can result from any nerve injury, not just chronic denervation as present in ALS and SMA. If untreated, nerve injury can cause atrophy as well. Before you get too concerned, you should get an MRI of the lumbar spine to make sure that you don't have nerve impingement. This is particularly important since you've had weird feelings in your leg, which would also be consistent with a pinched nerve.

Are you entirely in the clear? In my opinion, no—your EMG is indeed consistent with some kind of denervation. There are lots of causes for denervation, though, and the physical / mechanical causes (injury) are far more common in 25 year olds than ALS. Don't spend time worrying until you've had an MRI or other exam of your lumbar spine.
 
You must have MRI of lumbal & cervical spine. I am sure you have some kind of congenital disorder in your neck area, c5/c6 probably. You also should have to do CT of your brain & neck. NMD (ALS) is very unlikely in your age. Do not think about S. Hawkwing or something else who represents one in million cases!!! I am 51 and have had fasciculations, fibrilation, even giant waves in quadriceps all in EMNG done in 2005! Still running, walking, push-ups, tae-kwon-do etc... And yes; the last thing; I'm right handed where my muscles are smaller than on left side.
Slavin
 
tewest, Bandersnatch_F and slavin,

Thanks a bunch for your thoughts and perspective. I have had an MRI of the brain, C-spine and the Lumbar in June 2005. All were normal. Blood work including cpk, aldolase was all normal. NCV is also normal.

I do feel a slight pain in my lower back sometimes. But the MRI would have caught this- wouldnt it?

My calf still feels very tight. does it matter where in the calf they put the needle. My first EMG they put the needle right in the center of the calf, my second EMG was towards my knee but still on the calf. (TA?).

I thank you guys for hanging in here with me. Please walk with me for a little while. I am feelin a little alone.
 
Hey there again,

No I sure wasn't writing you off, the exact opposite, I can see your understandably anxious and my suggestion was to maybe get another opinion. Sorry if it came across the wrong way. I truely understand your worry, I have had an abnormal ncv result and have to be retested in march. I believe Troy is on the right track and everyone here will help you where they can.

Sharon
 
Your MRI could have been done too early. EMG symptoms in ALS typically precede the symptoms, so damage would usually be noted on the EMG before you were able to notice it. The opposite is true for nerve injuries—EMG changes typically take from 1–6 weeks (or more) to show up after the injury. Your MRI in June 2005 might indeed be "clean" (perhaps meaning "nothing major wrong"), but you might still have enough damage to a nerve to cause fibs and sharp waves later on. You might have also injured the nerve between June 2005 and now.

Nerve injuries are far more common than diseases like ALS and SMA, so don't assume that you have ALS when they haven't done any testing for pinched nerves. Also, have you had an NCS? A nerve conduction study can tell your neuro whether the sensory nerves are affected, and whether the signals are traveling more slowly along a motor nerve. Usually, they do an EMG and NCS at the same time; did they do that in your case?
 
My first EMG showed sharp waves and denervation in my legs. Here is what the spec lists wrote:

Needle EMG of selected muscles of the left arm and both legs was performed. Bilateral vastus muscles showed normal to long duration and normal to large amplitude motor units with reduced interference patterns and mildly reduced recruitment. Bilateral tibialis anterior showed occasional normal to long duration motor units. All other muscles tested appeared normal. No abnormal spontaneous activity was seen. This study shows electrophysiologic evidence of chronic denervation that can best explained by mild, chronic L-3-L-4 radiculopathy on both sides.

Needless to say I was in a state of anxiety because I focused on the denervation and my CAT-Scans, (can’t get MRI due to metal in my eye), showed only mild disc bulge. Fast forward 8 months, I had another EMG, after going through physical therapy and limiting my weight lifting and the results came back with “absolutely nothing”. Boy, do I wish I could have those 8 months back that were sheer hell. I was a zombie must of the time and now regret spending soo much time worrying.

As many people will tell you your EMG results can represent many things, please don’t assume the worst case. If I can assist, please don’t hesitate to contact me. Calm down and let some time pass and have another EMG in a few months. Until then, don’t dwell on all the negative thoughts. Take care, Mike
 
Bandersnatch_F is, in my opinion, the science god on this board.

Listen to him.

I have little to offer other than it dose not sound like ALS in its presentation or progression.

I'm going with a back injury/ problem or virus. Just not ALS.

Jeff
 
ammused? Are you? That is an odd name for someone who is fearing life, and limb. No doubt you have a perfectly reasonable explanation. Hopefully your amusement is not at the expense of the wonderful people on this board.

Basso
 
I wanted to ask you if your Dr. checked your CPK level? When was your first EMG after the twitches started? 4 years is a long time for a disease not to show up full force or at least have a Dr. tell if you have one. I say time is on your side and it is still BFS. You do not have clinical weakness or you would not be able to do all things as you say you can. So the Dr. is not seeing you for two more months, maybe you should get a second opinion. I know one thing, ALS is NOT it because most people are in wheelchairs by 4 years, if they are still alive at that. I do not know much about SMA and someone can correct me if wrong but burning sensations and pins and needles I do not believe is a symptom or even twitches, maybe, not sure...Doesnt your Dr. want to run some bloodwork to see if you have any virus or anything else? Keep us posted how everything turns out, I am sure you still have BFS, easy to say but try to relax and enjoy that new wife of yours....Jenn..God Bless
 
Basso,

I am not ammused at all. I just had this log in for other non-health related boards for a very very long time. I just used this so I dont have to remember more. I love the people on this board. I know a lot about the people on the board because I have been here a lot. Please trust me, I am not joking. I really fear for my life and limb.

Jenn,

I had my cpk checked in mar 2005, came back normal. I did have elevated cpk once (1600) after heavy exercise. This was almost a year and a half ago. I folloewd it with three clean cpk's.

Guys, If I have a nerve injury, I am supposed to feel the pain in my back or somewhere right? I dont feel constant pain. Only sometimes in my calf or hip. a faint pain in my butt occasionally.

I want to believe all of you that nothing is wrong. I really do. Just a little difficult. Basso, I really am not ammused at the expence of anyone. I am sorry it came across that way.

I get a slight tilting feeling towards my right side. Like my right feet dosent lie flat on the ground. I have been reading slavin's posts and like him, I feel it hard to brake sometimes in the car.
 
I don't think it has to be constant. Since this whole thing started for me, I've had some definite back issues and when I'm having the back/sciatic pain the twitching gets worse...I haven't had an EMG but I'd be willing to bet I've got something going on with the nerves in my back...the pain is not constant but is mainly in my LB, hip and IT band (down the outer part of my leg) and wraps around to my knee. Chiropractic adjustments have helped me considerably...and massage when I can coerce one of my friends to trade with me...

I would give your doctor a call to make sure you're both on the same page- his "wait and see" might be completely different from what you are thinking as I think if he thought it was anything serious, he would have sent you to a specialist immediately. Maybe he's figuring it's just a weird reading that will work itself out...

Shelley
 
Yes, I had an NCV (completely normal) and then an EMG (Occ. Fibs, waves, red recruitment). I will start going to the gym from today.

My concern is this. Between last July and now, I did go to the gym and worked out on my right quad (which is weaker) despite this it has gotten smaller and a little weaker (not sure if imaginining, most likely not)

So, does exercise make any disease that I have (SMA or whatever) progress more rapidly.?
 
ammused,

In Aug. I had a dirty emg. the two that followed were clean. I had to go through MRI and Lumbar pucture plus many sleepless nights and blood tests, however in the end they found that I have BCFS. Stay calm and be happy enjoy each day no really knows when we will be called for.

I am still new to this and by no means an expert however I have found much comfort knowing other people understand what I am going through.

Stay strong and positive.
 
Keep your head up. Your condition could be due to a number of things. I started twitching in 1999. I went on an EMG binge during 1999 and 2000. The first handful of EMG's were normal, but they progressively got worse. The first "dirty" EMG was due to "profuse fasciculations". Several EMG's later I received a dirty EMG due to fasciculations and fibrillations. Later I went on to get an EMG that had PSW's.
Of course I had all the symptoms that you had.....and more. The main symptom was "out of control" full body twitching 24/7. I had the cramping, hyper-reflexes, weakness, blah blah blah. My left quad was noticeably weaker. I worked out at the gym frequently and really noticed a drop-off. Well......almost 8 years later......all is well. I still twitch, but much less than I did in 1999. I still perceive some weakness, but hey, I golf every weekend. I will probably never get an answer as to what happened, but I guess it doesn't really matter any more. All is well.

All the best

D-
 
Dave,

Your post gives me a lot of hope. I just had an Ok day at the office this morning, until I started doing some strength check's in the conference room. only to reaffirm that my right quad is weaker. Then, I saw your post. I am hoping things will be ok with me too like they are with you.

Thanks again.
 
Amused,

You certainly can't go on self diagnosing yourself. Until you here that this is "als or sma" its not.

What i would do is to call the 800 number for als information. They will give you the closest center in your area for you to go to that has "definite muscular disease specialists" on board who see als all the time, everyday. You need them to look at you and your reports and give a diagnosis to you. You have too much fear to be rational. Ofcoarse your human. but give yourself the gift of peace of mind and go to the best. There is an als center in every state. They will tell you what you need to know. My gut feeling is something benign. I will pray in the meantime for your wellness and for courage to do what you need to.

Regards, Chris
 
Another thing about ALS is that I think it starts distally, so your quad would not be a likely place to start. Something else for you to consider in your favor as well.


Best wishes,



Chris
 
Today, I found something else that freaked me out.

pes cavus: It is a condition where you have an abnormally high arch in your feet. If it is not symmetrical that could indicate a NMD.

I have pes cavus. My MD pointed it out (only this one pointed it out, the previous neuro's did not). This seems to be more a symptom of SMA. Also I read that the weakness in SMA could start in the proximal muscles unlike ALS. My right quad is week and smaller. One more symptom I have is that fluids (phlem) seem to accumulate in my throat more...dont know if I am imagining it. and to top all of this I have a dirty EMG.

I will visit the MD again in 20 days or so to see what he thinks. SMA seems likely. I am begining to deal better with my morbid thoughts.

One last thing, my MD gave me some antoxidants and vitamin B12 and that seems to ease my cramps a little. This might help people suffering from BFS too...
 
Amused...

I have the gauntlet of symptoms you speak about minus atrophy (at least I think..) I have had body wide twitching but mostly in my right calf. It's been over a year now for me. Tewest and Jeff can account for my yearly endeavor. You have to move on...! I still have weird crap going on but hey what am I gonna do? I have seen so many neuros, docs etc... I started hitting the gym, watching what I eat and enjoying my booze again. Even though I have weird toe pain that hasnt gone away in a month! What is it? I don't know. Am I scared... of course. But what can you do about it? See another DR? Why? enjoy life! your walking talking eating so go get off the pc and enjoy it!

My toe pain is weird and with the twithcing history it scares me. It only hurts when I try and move the toes. I can move em up and down but not spread the little toes apart. But I can on my left foot. My wife told me she can't do it either on one of her feet. What I'm trying to get at is just calm down a bit and enjoy life. I'm gonna continue working out thorugh the toe pain, twitching and shaking. I can still put up some heavy weight! You should do the same
 
I have been trying to remind myself that I should not focus on my symptoms. I was successful in avoiding the internet completely for the last 3 days. Now, I feel my leg has worsened a little. When I climb stairs, my knee hurts a little. It had me so scared, I looked up stuff on the web again and only to my dismay.

Guys, what is the process to visit Mayo clinic? Will they give me a definitive answer that I can trust. Or will they also ask me to wait for a couple of months? I would like to initiate steps to go there...

Thanks for the help.
 

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