Twitching tricep very subtle for 9 weeks every second...

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Re: Twitching tricep very subtle for 9 weeks every second...

Postby TwitchyDoc on January 19th, 2014, 9:03 am

Anxiousguy: Sounds like quite extensive EMG, good enough to rule out MND.

Rothaar:Yes, to rule out ALS by the it is suspected, EMG is done in each spinal segment (i.e. upper extremity, paraspinals and lower extremity)+ bulbar. But in reality, if there are fasciculations with ALS, you expect to detect neurogennic changes in that limb and hence if the EMG is clear, it is unlikely the fasciculations are caused by lower motor neuron damange. WIth the onset of widespread fasciculations, more careful EMG is advised as there is seemingly not a single site of onset. As you mentioned the respiratory onset, this is another example where EMG is clear despite widespread fascicalations because it is very difficult to perform the EMG of diaphragm. But there is clear respiratory involvement, typically presenting as dyspnea in supine position.
And you are right of course, when bulbar onset is suspected, EMG of tongue is done as well as of other muscles innervated from the bulbar area - this is due to the fact that many people simply cannot hold their tongue still and hence it is very difficult to obtain clear results.
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Re: Twitching tricep very subtle for 9 weeks every second...

Postby Anxious guy on January 19th, 2014, 2:26 pm

Hey doc I kinda worry it was too early as I got it about 5 weeks into my latest twitching episode! And my twitching got worse in the weeks after the emg but I kinda get good and bad periods !
I got the emg as my tongue was twitching but it stopped after 14 weeks but I worried so much my anxiety was sky high and I began twitching all over and that has not stopped !

I've hear the emg is sensitive and would be able to detect problems early on and I did get everyain section of my limbs tested...
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Re: Twitching tricep very subtle for 9 weeks every second...

Postby Rothhaar on January 19th, 2014, 2:44 pm

TwitchyDoc wrote:Anxiousguy: Sounds like quite extensive EMG, good enough to rule out MND.

Rothaar:Yes, to rule out ALS by the it is suspected, EMG is done in each spinal segment (i.e. upper extremity, paraspinals and lower extremity)+ bulbar. But in reality, if there are fasciculations with ALS, you expect to detect neurogennic changes in that limb and hence if the EMG is clear, it is unlikely the fasciculations are caused by lower motor neuron damange. WIth the onset of widespread fasciculations, more careful EMG is advised as there is seemingly not a single site of onset. As you mentioned the respiratory onset, this is another example where EMG is clear despite widespread fascicalations because it is very difficult to perform the EMG of diaphragm. But there is clear respiratory involvement, typically presenting as dyspnea in supine position.
And you are right of course, when bulbar onset is suspected, EMG of tongue is done as well as of other muscles innervated from the bulbar area - this is due to the fact that many people simply cannot hold their tongue still and hence it is very difficult to obtain clear results.


So, you basically say that with widespread twitches only an EMG of all limbs (plus eventually tongue etc.) can rule out **S?! Not very reassuring when you had an EMG in one limb only like in my case.
Both of my neurologists, however, told me that they could rule it out with a clean clinical exam only and didn't need an EMG. It seems that neurologists here in Germany are generally rather reluctant when it comes to EMG's. Mine only performed them because they thought it might be necessary to ease my anxiety, but they didn't think it was necessary at all. Other opinions here on the forum seem to confirm this or say at least that an EMG in one limb is enough. So who is right now?

Can anybody please clarify this? It's really this kind of contradictory statements that is slowly wearing me down.
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Re: Twitching tricep very subtle for 9 weeks every second...

Postby Anxious guy on January 19th, 2014, 4:19 pm

Hi Rothhaar ! My neuro was like yours and didn't want to do the emg but I was stressed and anxious and he agreed to but said I didn't need it... I was concerned about the tongue twitching and the specialist doing the emg said he didn't need to do the tongue as it would show on other places as they share the same nerve pathway or something to that effect and then joked about testing my tongue if I really want too !
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Re: Twitching tricep very subtle for 9 weeks every second...

Postby Englishtwitcher on January 23rd, 2014, 1:17 pm

I have just had an EMG after 10 months if twitching and 5months of sciatic pain and twitching plus some tingling in my left leg. They did it on both arms, legs, including ankles and thumb plus under chin. It was clean but I'm still anxious. My left leg drivese crazy with twitching and all these feelings. I do know that I have a tight piriformis on the left side and what is lovely is when I sit on a spikey massage ball - it hurts but its nice at the same time! I do this for about 5 minutes and it really works. Try it and see. Sometimes tight muscles in that area can cause sciatica. I'm hoping that's why I have this in my leg.
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