How many EMG's are really necessary?

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How many EMG's are really necessary?

Postby JK498 on March 10th, 2004, 1:09 pm

I was just thinking about the number of people who have multiple EMG's conducted, myself included. It seems that in most of these cases it is based on the patients request and not the Physicians. After the first one that's clear, subsequent tests are done not out of medical necessity but to reassure the patient.

I am wondering if anyone has heard from a Neurologist on just how unlikely it is that a clear EMG would be followed by one showing signs of als. I'm sure there have been incidences of this. But do those fall into the category of "anythings possible" or does it occur an a frequent enough basis to say that it can indeed occur even if it is unlikely?

I do know from the Medhelp site that the replying neuro has stated that in the case of als, research has shown that the EMG will pick-up early signs of the disease. I actually posted a specific question on Medhelp regarding if an EMG could be done too early to detect als. The reply I received was that the test "may not show all the signs but it would be suggestive." My analysis of this response is that the test would probably show all the signs and at a minimum it would not be considered a normal EMG.

In summary, the main questions are...

1) Is 1 EMG enough?
2) Can the EMG be done too early?
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Postby Arron on March 10th, 2004, 8:34 pm

1 is the answer for the most part.

Your quote "I was just thinking about the number of people who have multiple EMG's conducted, myself included. It seems that in most of these cases it is based on the patients request and not the Physicians."

That pretty much tells te whole story.

Some neuro's will ask for a second EMG a few weeks, to a few months later, but usually that is just to cover their butt's. I don't know why, it isn't like if the patient actually did have ALS, that mis-diagnosing it would make any difference what so ever without any treatments that actually work. It's not like there's a time factor involved, like finding cancer or something early-on, where it can be too late to do anything about it if it goes un-diagnosed for too long.

1 EMG is plenty, especially if fascic's are already present, being that they are caused by active ALS in the first place. It also depends on how the EMG was taken. There are variables in everything, except death after life, so you have to take into consideration that the doctor knows how to property and thouroughly conduct an EMG.

Of course ANY one can goof one up I guess, or mis-read the results if the doctor was just lame or something.

Some might argue that you can have a negative EMG if you had fasics in say.... your leg and the doctor tests you in your arm. If this was the case, why in the heck would a doctor NOT test you where you are experiencing the fascic's in the forst place? That is like saying you have a lump in your breast and the doctor does a biopsy in yoru foot.

It is said (by competent neuro's) that if one has ALS, that an EMG would pick up sharp waves and abnormalities in just about any place on the body, BUT.... wouldn't it make sense to at least get checked WHERE the fascic's are located, just to make sure? Seems like a dumb thing to have to ask.... but many doctors seem to do this very thing according to MANY people's posts. Makes me wonder about what the doctor was thinking... or NOT thinking....
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