The conductive nerve study was negative as all readings for all 4 extremities were within normal ranges. On the follow up visit when we discussed the test results he said that a normal (negative) conductive nerve study rules out central nervous illnesses such as MS and ALS. Is this the case or should I pursue the opinion of a neurologist?

Will a SED rate or ANA be elevated for either ALS or MS?

I have an appointment with a neurologist in 6 weeks (I was not able to get an appointment any sooner).

Any other advice? My chief complaint is weakness in the front of my thighs and muscle twitching primarily in the lower legs but shows up in the thighs when they are tired. Twitching has shown up on my upper arms and occasionally in my hands, back and face. Sometimes I might go a day or two without a noticeable any twitching but when I am fatigued twitching is more common.

I should mention that the twitching started after I had a reaction to Septra about 2 months ago. I don't know if that was just a coincidence or not but the reaction was significant with burning gums, insomnia, loss of appetite and numbness in my legs from the knees down. Prior to that my main complaint was fatigue and numbness in my hands and feets. The numbness, which started about 4 months ago, seems to have gone away.

I should also mention that I have had what I would call long-term tiredeness, achiness, unrefreshing sleep and such for about the last 10 years. I had come to terms with those long-term symptoms but theses new issues are frightening.

I am a 43-year-old male with a desk job.

Thanks for your input. It is hard to wait so long to see the neurologist. I made the appointment over a month ago and still have 6 weeks to wait.

Actually, according to your own clinical experience How prominent is the acute denervation in early ALS? (PSW, fibs)

Have you seen any patients with MND (ALS, SMA, progressive muscular atrophy) who showed only chronic denervation (giant units) and no acute denervation at all in any of the limbs?

Is it possible with motor neuron diseases, according to your own experience? (Because It is not quite clear from the books)

My neurologist has told me that some MND's are very slow (for example SMA) and there for the chronic changes there are prominent.

1. Does it mean you NEVER see acute Denervation in SMA (fibs, PSW) but only chronic changes, because they are very slow diseases?

2. And about the chronic changes in MND (ALS, SMA..) you mentioned huge amplitudes... but what about highly polyphasic, long duration units? Why aren’t they ever mentioned with ALS or SMA in most textbooks?

3.what would be abnormal amplitude in ALS/SMA?

I will put it this way: if you Do motor unit analysis to a patient and you find out that most of his units are of 3 and 4 phases (rather than 2 or 1) would you be more concerned?

Here is a quote from a manual that made me think that 3 and 4 phases are not as normal as 2 or 1:

"Fasciculation potentials can be monophasic or diphasic, looking like normal motor units..." - Does it mean that normal motor units are only these of 1 or 2 phases?

I read that some polyphasic units are also present in healthy people:

1. Is it true according to your clinical experience?

2. (Would it be 10%, 20%. of all MUPs in a muscle that would be considered normal), yet is it totally normal?

3. Does it mean that there is a constant reinnervation-taking place in each one of us? Does it happen with tensed muscles

4.Are the "normal" polyphasic units you see highly polyphasic or just 5,6 phases (board line) or both?

Thank you again; I just could not find the answers anywhere!

2. This is also generally true.

3. This process is not usually a normal phenomenon. Reinnervation has to do with denervated muscle not with "tensed" muscle. It is the process which takes place by the surviving motor units after nerve damage to restore muscle function. It is a reaction of the healthy fibers to the loss of nearby fibers.

4. I do not know, although I did not see a "normal" highly polyphasic MUP, however, I think practically, it does not matter whether the MUP has 5, 6 or more phases. What matters is how many (%) are recorded out of 20/study.

The tests were interpreted thusly:

Fairly widespread changes in tongue, proximal upper limb particularly as well as lower limb consisting of relatively mild denervation and decreased motor unit output. May very well be MND.

Does this one EMG rule out other syndromes entirely? Blood serum shows elevated anti gm1 antibodies. What about axonal motor neuropathies, or immune mediated demyelinating neuropathies?

The elevated AntiGM1 antibodies can point to multifocal neuropathies, conduction blocks and the immune mediated neuropathies, all of which are treatable in one way or another.

By the way, I saw no mention of fasciculations in the symptoms or EMG findings you describe. WHAT about real weakness (like foot drop...) WAS it detected by your neuros? And what about fasciculation (can you see, feel them)

1.DO you get cramps, especially the ones that wake you up when you sleep at night?? 2.and about your weakness... DO you find it difficult to open a jar use a key to open a door, or even walk- It is important to understand how profound is your weakness

3.can you stand up without using your hands from sitting on the floor?? (Try it_

1. I have cramps but not intense enough to wake me. 2. My weakness is confined to the left side. Opening a jar, squeezing toothpaste are difficult with that hand. Although my left leg is affected I have no trouble ambulating. 3. I can still get up from a sitting position.

By the way, did your doctor tell you what he/she suspected as the cause of your symptoms?

1. In the diagnosis of ALS an EMG is administered in order to detect fasciculations. Since fasciculations come and go and are not continuous, as I understand them, what would happen if the EMG were performed on a day or a time of day when the fascics were not present? Would you get a false negative?

2. When receiving my EMG the neuro had me exercise against resistance each muscle being tested (i.e. the muscle w/ the needle in it). Is this in an attempt to generate and then detect resulting fasciculations? If not, what is the purpose of exercising the muscles?

3. I postponed my 2nd EMG because of a lack of fascics that day. Now that I'm exercising more the fascics are recurring. I'm scheduled for a 03 May EMG. Does this strategy make sense or are there certain EMG-detectable symptoms that may not manifest themselves to the extent that I can physically sense them?

1. In the diagnosis of ALS an EMG is administered in order to detect fasciculations. Since fasciculations come and go and are not continuous, as I understand them, what would happen if the EMG were performed on a day or a time of day when the fascics were not present? Would you get a false negative?

==> The EMG diagnosis of ALS rests on much more than fascics alone. It looks for denervation, active and chronic and the widespread distribution of the findings including in bulbar muscles such as the tongue. So fascics alone are not a diagnostic criterion to diagnose ALS by EMG.

2. When receiving my EMG the neuro had me exercise against resistance each muscle being tested (i.e. the muscle w/ the needle in it). Is this in an attempt to generate and then detect resulting fasciculations? If not, what is the purpose of exercising the muscles?

==> Yes, fascics are sometimes seen easier after exercise, so in all likelihood that's what your doctor was looking for.

3. I postponed my 2nd EMG because of a lack of fascics that day. Now that I'm exercising more the fascics are recurring. I'm scheduled for a 03 May EMG. Does this strategy make sense or are there certain EMG-detectable symptoms that may not manifest themselves to the extent that I can physically sense them?

==> Again, while it is good to see and study fasics by EMG, the diagnosis is not usually based on fascics alone.

Second, fasciculations and cramps are no the only signs of ALS, there are many others as you will see when you perform the search so your neurologist's reluctance to call them ALS may be based on what else he/she found in the exam and history.

If you are concerned however, it is not a bad idea to seek a second opinion, and if you still hear this is not ALS, ask your doctor to explain to you what these symptoms are.