Hey Duane, I have a reply for you and everyone.

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Hey Duane, I have a reply for you and everyone.

Postby Bradford on June 7th, 2004, 11:53 am

Duane,

Sorry to hear about your report. As a word of encouragement, you post some things that are inconsistent and because of the inconsistency it should be encouraging. What I mean by that is that your entire clinical picture is not based on isolated findings of fibrillation potentials and positive sharp waves alone. The entire history, physical exam, EMG/NCS and progression are all considered equally to paint the picture of your health. A ruling out or diagnosis will not be made on isolating the fibs and positive sharp waves alone.

It bears saying that muscle disorders can also present with findings of fibs and positive
sharp waves. In fact it is argued the positive sharp waves are the same thing as fibrillation potentials but seen from a different perspective from the probe. So if you put your self in your physicians shoes, it is very understandable to have a report such as yours. Based on information you’ve posted, you have many inconsistencies that are in your favor.

Even within the EMG/NCS the physician must take a “holistic” approach and evaluate many other things that would be consistent to a motor neuron disease. It is true that fibrillation and PSWs are considered a denervation potential. It is my understanding
(anybody can feel free to correct me) that it is a result of muscle fiber being reinervated as adjacent neurons receive a message to branch and spread across the fibers that have lost their neuron path.

When this happens, the motor unit potential during a contraction has a larger amplitude than normal giving further evidence (or lack of) to suggest a motor neuron disease. Also, the compound motor unit potential will be severely decreased. This is an evaluation of all working motor neurons. In a full strength contraction, the motor units fire at different time intervals thus they interfere with each other. This is called complete interference and is normal. In contrast incomplete interference is a result from reduced motor unit action potentials as a whole. Just from what you’ve posted, we don’t have that information.

The NCS study is directly related to amount of mylentation of the nerve fibers. If conduction is decreased it may be results of local injury, scarring, or blockage due to loss of neurons. Here again, decreased findings are non-specific to the pathology, and other neurological deficits must be considered in whole. By the time you have decreased conductivity in the context of a motor neuron disease, I would expect that weakness and other neurological deficits like changes in reflexes would be obvious on the physical exam. That is the premise that our neurologists practice upon.

Your physician will take ALL the information ranging from history to the fine details on the EMG/NCS to find a consistent picture. Having fibrillation potentials consistent with denervation yet having no weakness and other neurological deficits is “inconsistent” and in you favor. That is at the heart of my post and encouragement to you.
Bradford
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Hey Duane, I have a reply for you and everyone.

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