How early is too early for an EMG?

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How early is too early for an EMG?

Postby Arron on September 14th, 2002, 11:05 am

I see this question all of the time by people that started twitching and then went to their doctor to get checked-out, only to have a clean EMG yet still continue to wonder..." what if my symptoms were too early and the EMG didn't pick-up on early onset ALS?" Well, here's my point of view on it, for what it's worth. Keep in mind, I'm not a doctor but I am pretty "up" on all of this stuff and I think I have a pretty good grasp on it all.

Just like HIV, the Flu, a cold or anything that you catch or "aquire", there is always an early stage (or incubation period) at which point, no tests will pick-up on it BUT there are no symptoms yet either. That was the big delima with HIV for over a decade. Well, ALS or any NMD or anything for that matter also has it's early stages where even an EMG or blood test can't pick it up BUT, let's put this into perspective, (so don't go getting all scared yet, there's no reason to).

If you consider what ALS is (disconnecting nerve circuits between the brain and the muscles which causes total loss of muscle control once they have severed their communication pathways), SO, as the muscles become disconnected, they start to twitch and the twitching is usually very fine. Being that the nerve endings are disconnecting, you usually don't even feel these tiny twitches because there's no nerve pathway to send the "feelings" to the brain. Are you following me here?

OK, let's continue... the twitching is SECONDARY to the first symptoms, even though you haven't even noticed any weakness yet, the twitches are still secondary, meaning they don't start until AFTER the nerves begin to disconnect. By the time you start to notice twitching (or weakness for that matter), ALS has already started its course and by the time you notice any weakness (whether you felt any twitches or not), the ALS has already started. So, what am I getting at? It's simple, by the time YOU notice anything that would warrant seeing a doctor (twitching, weakness, etc.), whatever you have (be it benign or an NMD) has already started and certainly an EMG would pick it up (or not if it's benign). If the EMG doesn't pick-up anything, and you have symptoms of twitching withouit clinical weakness, wasting or atrophy, it obviously can't be from ALS or anything else "bad", so a benign condition is diagnosed. The "general" term used for this benign condition is BFS.

I don't particularly care for the name BFS. I honestly believe it is a "lebel" that blankets a whole slew of symptoms that very well could be one in the same with Fibromyalgia and several other benign conditions. So keep in mind, that when you are given an EMG because you have twitches and it was clean, yet you still wonder if it was too early, and maybe it "missed something", yes, ANY TEST can be too early but NOT once symptoms have started, especially if it is twitching, which is a secondary symptom.

Well, I hope that helped ease some of your minds. Keep in mind, ALS has certain symptoms and signs that a trained eye can notice. It is VERY rare (between 12 and 16 cases a day are diagnosed out of 400,000,000 people) Only about 5,600-5,800+ peope a year get diagnosed with it. That's an incredible ratio considering other things to worry about such Cancer, AIDS, Hepatitus, Multi Drug Resistant TB, aHantavirus and even Polio is making it's come back among umpteen million other things. So, when you walk into a neuro's office and he says he can spot someone with ALS about the minute they walk through the door, they are usually right, so trust them, quit worrying and get on with your life. I have wasted too much of my own life worrying because I was SO scared I had ALS becaue of poor information in medical books and the internet, and that's why I am here, trying to help you NOT make the same mistakes I made.
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Great Post

Postby j1 on September 14th, 2002, 3:53 pm


Great Post...once again you have come through for many. This is some good information and puts me @ ease already! Thanks.
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Postby SusanSid on September 14th, 2002, 11:54 pm

:lol: Thanks Aaron, so well put!
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