So I had an idea to help people here...

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Re: So I had an idea to help people here...

Postby chrissi on January 19th, 2014, 6:02 am

chrissi wrote:And one more for the arch twitch community:

Fasciculation potentials in foot and leg muscles of healthy young adults.
Van der Heijden A, Spaans F, Reulen J.
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Department of Clinical Neurophysiology, University Hospital, University of Limburg, Maastricht, The Netherlands.
Abstract

The occurrence of fasciculation potentials (FPs) was studied in healthy subjects aged 18-25. In 25 males and 25 females 3 intrinsic foot muscles, the tibialis anterior and the gastrocnemius muscles on both sides were monitored with surface electrodes for 2 min periods. Only potentials with a peak-to-peak amplitude of at least 50 microV were counted. The number of FPs per minute (FPs/min) was significantly higher in the abductor hallucis (AH) and significantly lower in the tibialis anterior as compared to all other muscles (P < 0.001). Men had significantly more FPs in the AH than women (P < 0.05). In all subjects FPs were found in at least 1 AH. Cooling of the foot did not influence the numbers of FPs/min in the foot muscles. To study diurnal variation, all 5 muscles on both sides were monitored 3 times/day on 10 different days in another 10 subjects (5 males, 5 females). Only in the tibialis anterior did the number of FPs never exceed 3/min. In the other muscles considerable fluctuations were found, especially in the AH, where more than 100 FPs/min were occasionally recorded. In the course of the day a significant (P = 0.05) decrease in FPs/min was found for the AH muscle. In 8 subjects there was a significant correlation between the numbers of FPs in the left and right AH during successive recordings. This indicates that an, as yet unknown, general factor determines the fluctuations in numbers of FPs.

Did you read that??? Normal healthy people occasionally show more than 100 true fasciculations per MINUTE in their arches!! This is not BFSers, it is normal people!
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Re: So I had an idea to help people here...

Postby chrissi on January 19th, 2014, 6:03 am

chrissi wrote:Fasciculation potentials in healthy people.
Mitsikostas DD, Karandreas N, Coutsopetras P, Piperos P, Lygidakis C, Papageorgiou C.
Source

Athens University, School of Medicine, Department of Neurology, Aeginition Hospital, Greece.
Abstract

The aim of this study was to investigate the fasciculation potentials (FPs) in the small-peripheral muscles of the foot and hand and the possible associated factors, in a healthy population. One hundred-twenty-two normal !!!!!! (not originally diagnosed BFS persons!!!)individuals (65 men and 57 women), aged 17-67 years (mean 39.96, SD=12.76) participated in the study. A special questionnaire consisting of 47 questions was devised as the basic instrument of the interview, which included the Hamilton anxiety rating scale. The extensor digitorum brevis (EDB), the flexor hallucis brevis (FHB) foot muscles and the first dorsal interosseous (FDI) hand muscle muscles were studied bilaterally using surface electrodes. In 94 (58 men and 36 women) from 122 participants (65 men and 57 women) FPs were recorded (men 89.2%, women 63.1%, all 77%). The mean FPs per minute and muscle, in all three muscles, was 8.0 (SD=4.6). More FPs were recorded in the muscles of foot than in FDI (p<0.01) and in FHB than in EDB (p<0.001). FPs were correlated to gender, body height and weight and to the score of the Hamilton scale (r2>0.1, p<0.01). The syndrome of benign FPs was observed in 2 men (1.6% of men). These results suggest that FPs are a very common phenomenon in the peripheral muscles of healthy persons.

Point one: normal people twitch
point two: they do it in ther feet and hands which makes it widespread
point three: the number of fasciculations is correlated to the anxiety level
Point 4: 1,6% of men suffer from benign facsiculation syndrome.....that is almost 2 in 100 People compared to 2 in 100.000 in ALS ...I might err but....doesn't that say that BFS is a thousand times more common than ALS??
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Re: So I had an idea to help people here...

Postby chrissi on January 19th, 2014, 6:07 am

Oh sorry, this is the wrong thread...
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Re: So I had an idea to help people here...

Postby J4son on January 19th, 2014, 7:08 am

Xina535 wrote:
J4son wrote:- None here among the thousands of people on this forum whom were given a diagnosis of benign twitching developed ALS.



New member here - I've seen this a few times, a statement that no one on this forum has ALS. I've wondered if that's really true, or how that is known. Maybe it's explained on here somewhere and I've missed it.



Xina I didn't say that no one on this has ALS. I said that No one on this forum who received a diagnosis (by a neurologist) of benign twitching, developed ALS later. In the 2 or 3 exceptions on this forum the neuro suspected MND or possible MND from the start.
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Re: So I had an idea to help people here...

Postby Xina535 on January 19th, 2014, 8:02 am

Thanks Jason for clarifying that. I understand the difference now, thanks!
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Re: So I had an idea to help people here...

Postby Rothhaar on January 19th, 2014, 2:46 pm

Just an example for the contradictory statements which bother me so much:

viewtopic.php?f=5&t=20065&p=151229#p151229
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Re: So I had an idea to help people here...

Postby Gamindsoc1509 on January 19th, 2014, 4:07 pm

Rothaar, if you are referring to clinicals vs EMG. I don't really believe EMG is necessary to rule out ALS. My understanding is that EMG's are used to CONFIRM ALS. The clinical is used to check for suspicious clinical changes.

That is why many neuro's won't bother with the EMG or will only do it to make the patient feel better. My neurologist said it was a waste of time and he is very highly regarded.
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Re: So I had an idea to help people here...

Postby MarioMangler on January 19th, 2014, 4:32 pm

Yep no one here has ever really needed an EMG. That is one of the other misconceptions around this place. An EMG doesn't really solve anything or fix anything or tell you anything. It's mainly just done so the doctor will get a patient to shut up. And it really doesn't even do that for the most part with BFS people, because most of the people who get one will then go get a second (or third) one later. This is why I advise people not even to bother going down the EMG path. It is just a big waste of money that you could be spending on other stuff, like vacations or your family.
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1. No, that's not bulbar
2. No, the location doesn't matter
3. Yes, we have all had that symptom
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5. No, that's not ominous
6. No, you don't need an EMG
7. Yes, you will be fine
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Re: So I had an idea to help people here...

Postby Rothhaar on January 20th, 2014, 7:33 am

Hi Gamindsoc,
Hi Mario,

thank you very much for your answers. That's a great relief.
There seem to be to opposite schools of thought when it comes to the role of EMG's (TwitchyDoc obviously belongs to the other school). But I think you are right, especially because your opinion seems to be the standard opinion among neurologists as well.

I guess, most neurologists in Europe don't want do EMG's after a clean clinical, because it's just not the medical standard procedure according to the relevant guidelines. In the US it may be different, albeit probably not so much because of medical reasons, but they want to cover their backs.
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Re: So I had an idea to help people here...

Postby chrissi on January 20th, 2014, 7:59 am

Most docs here (germany) will not order an EMG for fasciculations, because that is simply overkill. Fasciculations without any other problems, have no diagnostric value. The EMG specialist in Mannheim University hospital even has benign fasciculations himself (and was able to show it) , and never had the idea to get an EMG because of that.
His simple answer: because fasciculations are damned common and are not a sign of anything bad. He is working for the ALS group there and has done thousands of EMGs, and many of them on ALS patients. He never saw a patient whose fasciculations were a precursor for MND. Either they accompanied weakness, or the patient did not have ALS.
They only did the EMG because I had numbness, extreme hyperreflexia and terrible pain and stiffness and tremors. I was so shaky I could hardly walk. Honestly, they did not even care about the fasciculations.
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Re: So I had an idea to help people here...

Postby Xina535 on January 21st, 2014, 11:42 am

I am sorry Chrissi, to hear you had those issues. I hope you are feeling better by now.

I am also in Germany by the way (near Düsseldorf). Although I am somewhat a new neurology patient, I have also felt like the doctors find EMGs overkill (and in general with tests, they do them when they feel absolutely necessary). What I find is a downside to this is they treat you based on what they think you have, without having a real diagnostic image first, and as long as the treatment helps, then they will keep doing it that way, especially for younger patients (for cost purposes). One of my ex primary care doctors even told me that. Turns out, I had 2 herniated discs for a long time and they just kept giving me shots in my shoulder/neck. After I was properly diagnosed (MRI in a hospital, where I went one day when I couldn't feel my arm), I received rehabilitation and finally feel real long-term relief now.

THIS:

"He is working for the ALS group there and has done thousands of EMGs, and many of them on ALS patients. He never saw a patient whose fasciculations were a precursor for MND. Either they accompanied weakness, or the patient did not have ALS."

is great to know, very reassuring! Thanks for sharing!
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Re: So I had an idea to help people here...

Postby Rothhaar on January 21st, 2014, 1:03 pm

Hallo chrissi,

na dann erst einmal viele Grüße nach Monnem!

And of course thank you the insight provided about EMG's and BFS. Makes me feel a lot more comfortable!
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Re: So I had an idea to help people here...

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