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Dr. Martin Turner & Twitching

PostPosted: September 29th, 2015, 7:37 am
by misterjuanperalta
A fellow twitcher (adam4little) wanted some clarity on the subject of twitching, even with tongue involvement. Dr. Martin Turner is contacted and responds as follows:

"Hello, I regret the anxiety caused. You are not the first to write to me! It is in a patient presenting with progressive weakness (of the limbs and certainly slurred speech) that tongue fasciculations are NOT benign. Fasciculations without weakness, including the tongue, are usually entirely benign (and I don't perform an EMG without weakness because it is not a diagnostic tool in this setting and actually has quite a limited role in the work-up of ALS).

EMG is only 60% sensitive for the diagnosis of ALS in the best hands, and it does not out-perform an experienced neurologist's clinical acumen. But this is 60% in people who are presenting with weakness or slurring. I request an EMG to look for denervation in apparently unaffected areas (i.e. no fasciculations or weakness) in such a person who has come to me with single limb weakness or slurred speech to build a case for wider involvement. In 15 years of seeing probably near 1000 ALS patients, there were not that many times when EMG told me more than I already knew from the story and physical examination.

I can understand why some neurologists perform an EMG for benign fasciculations to try to reassure people, but if there is no weakness or slurred speech, then a person does not have ALS and I am not sure what it would mean if there was detectable denervation without weakness (other than a lot of anxiety and repeated testing). That's why I don't do it in that setting."

Interesting and positive response.


Re: Dr. Martin Turner & Twitching

PostPosted: September 29th, 2015, 7:55 am
by garym
great post....addresses pretty much all that needs to be said about bfs/als.