emg questions and symptoms

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emg questions and symptoms

Postby Tb12 on June 1st, 2013, 12:50 am

Hi guys,

i have posted here before and people have been a great help. I have a few questions, hopefully someone could shed some light and advice.

my symptoms to this day:
all over muscle twitches, myoclonic jerks
action tremors in arms, legs, shoulders, neck...could be weakness?
current GERD and biting tongue, saliva production, scalloped tongue, jaw stiffness/soreness
some sensory issues like pain in muscles and tingling feelings

and recently a lot of twitches in face, lip, neck, throat and both shoulders and mid upper back/middle of chest are in a lot of pain, shoulders feel like they subfluxed and or arthritc pain and really weak, hard to sleep on.

emg readings and questions:
I had my first emg which was a concentric needle emg off my left upper and lower limbs that found definite large amplitude units seen suggestive of some mild chronic denervation and the neurologist said further muscle sampling should be done. this may have been a single fibre emg, i am not sure.

my second emg months later as a follow up was a quantitave emg on my right upper and lower limbs and some upper left limb sampling and it was a clean emg and no denervation, only found one fasic in my right deltoid. neurologist wanted a second opinion from someone he trusted in the emg field.

3rd emg done a few months later was done again on right side upper and lowee limbs and was completely clean.

My question is, is quantitive emg different to single fibre? is there a difference in the testing as all 3 emg's seemed to be done the same to me. Would the last 2 emgs mean i am clean? or should i be trying to follow up the suggested findings on my emg? would als signs definitely show up regardless of emg type?...i am sincerely confused.

as far my neuro clinical exams they have all been deemed as normal, however my action tremors have been seen and noted but it was stated that it was not indicative of mnd signs on clinical exam.

any advice at all would be helpful
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Re: emg questions and symptoms

Postby TwitchyDoc on June 1st, 2013, 4:15 am

I have seen your older posts and you did mention gynecomastia and smaller testicles issue - have the doctors checked the Kennedy disease? As this "benign" MND is characterized by fasciculations, gynecomastia, hypogonadism, tremor....Fasciculations around the lips and chin are pretty common part of the clinical picture.
Kennedy's disease does not shorten patient's lifespan generally and progresses extremely slowly and there is a blood test to cofirm.
Not saying you have it but under these circumstances if is something that should be definitely checked. It is inherited, yet it is not uncommon for patients to have it without previous history (e.g. when mothers were carriers etc.).
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Re: emg questions and symptoms

Postby Tb12 on June 1st, 2013, 4:32 am

Hey there, thanks for the reply and advice. I too believe I have a lot of symptoms pointing towards Kennedy's disease. And thanks for remembering my history. I mentioned Kennedy's disease to my gp and she looked at me blankly and said we can't do tests for that. I bought it up with my one of my neuro's and he looked at me and said no way, you would have noticeable atrophy etc and didn't want to go near the tests. I also got a test done on my testicles becauses my Gp was the one who said they were small, however after the ultrasound he said they came back in normal size range, does that clear me from hypergonadism? ... Should I push and get these tests done?.. Wouldn't Kennedy's show emg abnormalities? I know I have had one bad emg, I am so confused as to why the other 2 latest ones are clean.. When chronic denervation showed up on the first one.. I'm trying to tell myself the first one was a botch but it's hard.
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Re: emg questions and symptoms

Postby TwitchyDoc on June 1st, 2013, 4:51 am

Well, you should definitely push for the tests because the combination of gynecomastia and generalized fasciculations is particularly specific. You should go to a specialists as with Kennedy's disease it takes a long time before the atrophy develops, it can be a decade or more. The very first family members (studied by dr.Kennedy), some had fasciculations 8 years before a hint of progression appeared..which is a good thing, on the other hand. On EMG there are typical giant motor units, if I remember correctly but it takes some time for them to appear (it is a reinnervation sign).
Sure, might be totally unrelated and it is good you discussed this option already. Anyway, I would insist on the tests to know. If in your country you cannot just say "do it", then I hope a specialist will help and do it as a part of differential diagnosis.
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Re: emg questions and symptoms

Postby wimpy39jen on June 1st, 2013, 7:32 am

I have the action tremors too and that was my same questions, how do I know the tremors are not caused by muscle weakness...so I worry about the same stuff. I have never had a EMG, just an EEG on my brain and my doctor (two of them) keep telling me it is all caused from anxiety and muscle tension. I think though in your case you have had many EMG's and clean clinical exams by a neuro so I would think you are cleared of anything sinister.
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Re: emg questions and symptoms

Postby Tb12 on June 2nd, 2013, 1:57 am

thanks heaps for all the suggestions and advice guys. I am just wondering if anyone on here knows more about dignostic testing for kennedys disease, i know theres a special blood test that can give you a staight answer, im just wondering if my last 2 emg'S have been clean and my CK level is within normal limits should i push hard and spend money to get the dna test for it, or would a clean emg and a normal ck level rule kennedys out?

also anyone know what neuromyotonia is? and could my facial/neck and arm twitching be related to tmj at all? i have not been diagnosed with it, just a thought.

also does anyone have more twitching as soon as they wake up? when i wake up my arms,neck,face are going crazy...but during the day there is a huge decline and there has been a huge decline in my twitches in general....its more the tremors and facial twitches, tongue biting thats bothering me.

trent.
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Re: emg questions and symptoms

Postby TwitchyDoc on June 2nd, 2013, 4:54 am

Low CK levels are very reassuring (especially in KD) and so are the EMG's, yet the presence of generalized fasciculations,, gynecomastia and tremors is very suspicous and strongly point to KD, unless they find a cause for these low testosterone symtoms.
I live in a state where fortunately I can ask for any test for free so I cannot advice on that. If it is KD, there is nothing much to do anyway and you will just live with it. It would be especially important if you plan the family.
For your question, CK and EMG does not rule it out (as I mentioned, a lot of KD patients have cramps or/and twitching even a decade before the first hint of progress) but gives you the reassurance that IF it is KD, it is its earliest beginning.
On the school, we had a neurophysiologist with KD, in his 70, he had just trouble walking.
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Re: emg questions and symptoms

Postby Tb12 on June 2nd, 2013, 5:26 am

thanks for the information, i think i'll push my neurologist just for peice of mind. so its a very slow progressing disease? will i always be able to talk? and walk? will it just create certain difficulties in these areas? i dont know too much about it at all. Hoping i just have bfs. I had gyno when i was in my early teens and had it removed...not sure if that makes a difference.
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Re: emg questions and symptoms

Postby TwitchyDoc on June 2nd, 2013, 6:04 am

Well, of course not, the gynecomastia is just a sign, not the cause. If you mention this problem, generalized fasciculations and tremor, every good neurologist will test you for KD. And as for the progression, yes it progresses over decades and does not shorten the lifespan. It is slightly different for every patient but it is nothing like ALS.
Sure it might be just BFS, I am concerned because of the combination of quite specific low testosterone symptoms.
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Re: emg questions and symptoms

Postby Tb12 on June 2nd, 2013, 7:12 am

thanks so much for the info. i am going to request a test for sure.
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