Welcome Newbie - Widespread Twitching

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Drewbacca

Well-known member
Hi everyone,

I am new here. This is a wonderful site with kind people who are willing to reply to others concerns !!!

Have a history of widespread twitching for 9 months (started with eyelid, then sporadic twitches for 1 month about once in few days and then suddenly all over with several in an hour).

Got checked by a Neuromuscular person (for the first 6 months at which point I decided to do an EMG to try and stop making doctor visits). EMG was only done on 8 muscles ion the right side consisting of leg, arm, hand and paraspinal) and was normal. However, physically, I have lot of trouble with pain (mostly tendons but sometimes muscles and joint ligaments too), muscle tightness and exercise intolerance.

I have a few EMG questions that some people with indepth understanding may be able to answer :

1. How long typically one should wait to get an EMG ? Is it true that any changes in EMG show up only after weakness or atrophy ? (why would the Neuro's resist doing it until then)

2. Is seems that the EMG protocol is that if the (same) muscle is not sampled at 7-9 places then it might miss any neurogenic changes. Well mine was only one poke per muscle (at a major univ. hospital which figures among top Neurology programs in the country). Is this others experience too ? If so, is this a reason for concern that something could be missed even though the muscle has twitched at some point and get another one ?

Best Regards.
 
I am new to the forum as well. My EMG was done on right side all muscles from foot to neck. Was told that you did not have to be showing signs at the time in order for the EMG to pick up anything. My Neuro told me that I didn't even have to be feeling any fascics in order for the EMG to be accurate. She indicated that once you are experiencing the twitches, you should already be experiencing weakness, etc. and all this would show up on your EMG. She told me most people she has diagnosed with the dreaded *** came to her complaining about the weakness and not even noticing the fascics. She said even if I didn't specifically feel or see any of these things, the EMG would have picked them up.
 
I don't know of any neurologist that will poke the same muscle twice on an EMG. Individual muslces on seperate parts of the body are innervated by different nerves; therefore, if you have something wrong with that 'nerve' it will show up on the needle stick regardless of where in the muscle it is placed. Think of it like a tree - If the roots that give life to certain branches of a tree are dead, then it doesn't matter where you look on that branch, the whole thing will be dying.
 
Yes I would think so ...

However, Cleveland Clinic Neurologists seem to think differently. Just look at their answers to some of the posts about this.
 
The only Cleveland Clinic thread on this subject that I can find says "2-3 insertions are necessary to define muscle irritability" but then goes on to clarify:

"Insertions can be either complete new insertions or just movement of the needle in a new direction."

So (a) more insertions are only needed to "define irritabililty" (i.e. doesn't mean a serious problem would not be immediately apparent), and (b) changing the direction of the needle to sample other muscle fibres DOES count as a separate "insertion" as far as the CC is concerned.

The same neuro also says higher up in the thread (it's a reply to someone worried about bulbar ***) something along the lines of "to be frank, if you had it, it would have shown up".
 
I think a lot of this sampling of the same muscle is done when they move the needle around in the same spot.

If you're talking about an EMG to diagnose twitching, the EMG should show problems before weakness sets in if you were unlucky enough to be one of those rare cases of twitching before weakness sets in.
 

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