EMG question / concern

[AG17]

Hi - first I would like to thank whoever reads this for taking the time to do so.

I read the “read before you post” section and would like to thank the folks that put that together.

That being said, I had an EMG recently and I am concerned about how it was conducted. All of my symptoms have been left side specific. However, the EMG was conducted on my right side. When I questioned the neurologist about this he kind of ignored me.

The results for my right side were normal, which is great. However, should I be concerned that the side of my body with symptoms was completely ignored? Is this normal? Should I be pushing for a retest? Any insight would be greatly appreciated.

 

[Nikki J]

Hi
That is a hard question to answer. In ALS the emg usually shows abnormalities in places where you feel fine and sometimes they do the opposite side for that reason. If your left sided symptoms are wide spread I doubt they missed anything but it is possible in very early disease for it to be pretty localized.

Was the emg doctor your regular neurologist? What did your clinical exam show? What symptoms do you have?

 

[AG17]

Hi Nikki J

Thanks for the reply. EMG was done by my regular neurologist on my second visit. During the first visit he briefly spoke to me for about 5 minutes and that was it. Didn’t test reflexes or do anything of the sort.

Symptoms:
Left hand pinky is not working, and I have atrophy of the hypothenar eminence in my left hand. I also am unable to move the small toe on my left foot. I have fasciculations throughout my body periodically. I am occasionally dropping objects, and tripping while walking unexpectedly.

 

[Nikki J]

Atrophy identified by a doctor?

I would look for a doctor who actually examines their patients. This, as noted by another member, is becoming less common as they rely on tests. I am old fashioned and still believe there is value to history and physical but it is true that some of it is performative

 

[AG17]

My PCP was the one who noted the atrophy after I asked him about it. He took pictures and sent them to my neurologist. I had a follow up with my neurologist - who suggested that the atrophy could be due to migraines - he states that I do not have clinical weakness - good news.

My PT disagrees with my neuro - which is disheartening - she thinks I am showing clinical weakness.

I had an EEG conducted yesterday, and an MRI of my spine and brain completed this morning. Awaiting results on all those tests.

Thanks for answering the question about the EMG/NCS. I have one scheduled for tomorrow with a different neurologist.

 

[Clearwater AL]

During the first visit he briefly spoke to you for about 5 minutes and that was it.
Did not test reflexes or do anything else.

Neuros are experts of observation… from when you walk in the room, how
you sit, cross your legs, what you do with your hands even how you hold
your head. A good Neuro can almost see you don’t have ALS the first visit.

For others too…

But… to cover themselves they will order more tests. Why not?
Your first visit was profitable for him or the clinic he may work for.
EMS and NCS tests are expensive and based on a profit structure.
MRIs are expensive, blood work is expensive… none done at break even
or loss. Neuros, nurses, techs are paid well and the overhead expenses of
the facility, lighting, HAVC, maintenance.

You’re going for another EMG… I hope it turns out to be good news.
You’re lucky to get another appointment so soon. Many wait weeks
for a second Neuro appointment.

Again, I hope you get good news. Post the Summary/Conclusion when
you get it.