Confused about reinnervation and fibrillations

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Confused about reinnervation and fibrillations

Postby Xina535 on March 27th, 2014, 11:31 am

Hi All,

I read this response by Twitchydoc on TDenver's thread and it got me googling what 'reinnervation' means. I hadn't heard it before.

Reinnervation appears very early and is actually the reason why patients notice weakness when there is more than 50-80% motor neurons lost. The slower the denervation, the more damage can be compensated for by reinnervation. That is the reason why can have only 30% motor neurons remaining, fasciculations but subjectively there is no weakness - it is well compensated. But EMG will spot it easily.

I stopped googling since I shouldn't be doing that, and the above description is too technical for me. :oops: The way I understand it scares me, so I hope I am wrong! Would someone be able to translate that better? These are my thoughts/questions:

I read that reinnervation is what could be what causes, or IS where the twitching comes from. Is this only if MND is present, or is this happening with all of us BFSers? I THINK only in MND since he mentioned weakness. When he said the 'slower the denervation' - does that mean, 'the slower the twitching'? :?:

Twitchydoc also advised about fibrillations in his response.

I understand fibrillations to be small twitches. We can feel, but maybe not see them. But a fibrillation is very bad news, and a fasciculation is harmless, but an EMG can pick them both up. My question is...if a fibrillation is a small twitch, how can the EMG distinguish the difference? Will the fibrillation show up blue or in another color, or with a certain characteristic that is no way to be mistaken with a harmless fasciculation? I am scared to get an EMG for this reason. I have small twitches that sometimes I can't see and I wonder if that is a fibrillation and then I go through this, 'I want to know', 'No I don't want to know' crisis. :shock:
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Re: Confused about reinnervation and fibrillations

Postby wjjw on March 27th, 2014, 1:02 pm

Xina535 wrote:I understand fibrillations to be small twitches. We can feel, but maybe not see them. But a fibrillation is very bad news, and a fasciculation is harmless, but an EMG can pick them both up. My question is...if a fibrillation is a small twitch, how can the EMG distinguish the difference? Will the fibrillation show up blue or in another color, or with a certain characteristic that is no way to be mistaken with a harmless fasciculation? I am scared to get an EMG for this reason. I have small twitches that sometimes I can't see and I wonder if that is a fibrillation and then I go through this, 'I want to know', 'No I don't want to know' crisis. :shock:

Fibrillations are NOT fasciculations. TwitchyDoc can probably explain it to you, but they are something having to do with single muscle fibers and can ONLY be detected by EMG. The twitches you are seeing and feeling (or not feeling) are fasciculations. They are NOT fibrillations.

You are seriously causing yourself to remain in this horrible state of mind. I wish I could help, but I suspect you're going to keep doing this kind of "research" and torturing yourself with "what ifs" that do not even apply to you! You need to keep telling yourself you are fine, accept that you have BFS, and get on with your life. I suspect that not even an EMG will help you, because you'll just seek reasons to doubt it. But I hope I'm wrong about that. :-)

Cheers,
Bill
A knowledge of the existence of something we cannot penetrate, of the manifestations of the profoundest reason and the most radiant beauty, which are only accessible to our reason in their most elementary forms--Albert Einstein
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Re: Confused about reinnervation and fibrillations

Postby Xina535 on March 27th, 2014, 1:42 pm

Hi Bill, I don't like going to these sites and I try to avoid it as much as I can. I have mentioned on a couple threads that my therapist wants that I go to these sites to make myself more scared, so I can document what happens to my body and how I react. I only go enough to get some situations on paper for my appointments.

That's why I ask my questions here. I read something in a post on here so I asked questions about it on here (in this Questions About BFS forum). I did try to look it up myself it then stopped when I realized it was over my head.

I haven't heard about reinnervation before and am confused about fib vs. fasc.

You could be right that I may not believe the EMG if I ever decide to get one, but then again, if I did, I wouldn't be like most of BFSers, because I know I certainly would not be alone there. Many people (maybe even yourself?) needed to have multiple EMGs to search for reassurance, from what I've seen on here.
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Re: Confused about reinnervation and fibrillations

Postby wjjw on March 27th, 2014, 1:53 pm

Xina535 wrote:Many people (maybe even yourself?) needed to have multiple EMGs to search for reassurance, from what I've seen on here.

I never had an EMG and did not need one for assurance. I followed my own advise, the advise I am giving to you. I highly doubt that anyone here "needed" an EMG, and if having an EMG ever physically helped one person on this site (for example, by diagnosing an alternate problem and helping to correct it) I am just unaware of them. I have seen many, many people refuse to believe the results that were done to "ease their minds." To me that sounds like a kind of odd recommendation from your therapist and if it were me I would question it. Then again, I'm not a therapist (well, other than my own therapist) and I question everything myself anyway. :-)

Cheers,
Bill
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Re: Confused about reinnervation and fibrillations

Postby Xina535 on March 27th, 2014, 2:41 pm

I also think that many neuros thought that the BFS patients didn't really need the EMG, and did it to humor then or the BFSer paid for it themselves (which is what I am currently contemplating).

I still do not yet know what he has planned with this therapy. Every time I get another sheet to fill out, and each one has then yet another column to complete. Something along the lines of having me recognize exactly what is going on and that there is nothing to be afraid of, and getting me "tired" of being scared. I will see where it leads...
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Re: Confused about reinnervation and fibrillations

Postby TwitchyDoc on March 28th, 2014, 7:41 am

Xina, as Bill correctly stated, fasciculations are not fibrillations. Fibrillations appear in denervated muscle fibers and - except for tongue - cannot be seen clinically. They are electrophysiological sign of denervation and appear 2-3 weeks after loss of the axon - which is why recent denervation does not appear on the EMG immediately.

No twitching you can see or feel is fibrillation, I can assure you. In addition, they are regular and persistent, not like fasciculations that are by their nature variable. As Bill said, only EMG can detect them.

Reinnervation is nothing of your concern, be happy for that.
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Re: Confused about reinnervation and fibrillations

Postby Yuliasir on March 28th, 2014, 9:08 am

reinnervation is a process of getting some innervation back becasue, however slowly, axons might be restored, same is true for myelin sheets. So it is natural process of self-healing, and practically if reinnervation is trong and no further denervation occurs, then it is a healing as is.
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Re: Confused about reinnervation and fibrillations

Postby Xina535 on March 28th, 2014, 3:44 pm

Thank you all, this makes much more sense to me! I had no idea that the body can heal like that! And I very much appreciate knowing now that fibrillations are not felt!
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Re: Confused about reinnervation and fibrillations

Postby violetmom on March 31st, 2014, 7:57 am

So are you positive fibs can't be felt? Anyone?
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Re: Confused about reinnervation and fibrillations

Postby emmie.s on March 31st, 2014, 9:05 am

No, they cannot be felt. I've been here a while, and every now again I see this same question pop up here, and the answer is the same...you cannot feel fibs. A whole lot of people have asked if tiny twitches or vibrations are fibs, but thats a fib!
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Re: Confused about reinnervation and fibrillations

Postby violetmom on March 31st, 2014, 11:54 am

That was my exact reason for asking.. Very fast buzzing twitching :(
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Re: Confused about reinnervation and fibrillations

Postby wjjw on March 31st, 2014, 1:22 pm

violetmom wrote:That was my exact reason for asking.. Very fast buzzing twitching :(

Yes, they are very fast buzzing twitches, 100 percent not fibrillations. Thought maybe the sad face meant that you misunderstood.

Cheers,
Bill
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