Hi,
Thank you for getting back.
I have noted your history and the reports of current EMG.
In my opinion, you do not have bulbar onset ALS, as I agree with other neurologists that clinical examination would be abnormal. So, in my opinion, this EMG is not properly done, and you should disregard it. The EMGer should have clinically examined you, and he seems to have used faulty techniques, as it caused lot of pain. Also, no spontaneous activity was noted, which is unusual in ALS.
I hope it helps.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist
Patient replied :
Thank you so much. Right after this emg he scared me so badly. I really appreciate you looking over my reports
I was just surprised that just 4 months ago my emg was normal and now so many abnormal findings
Also als and bulbar wouldn't start at the same time right? Usually this disease starts on one limb than progresses right?
What is spontaneous activity?
So I don't have als or bulbar in your opinion?
Thank you so much, you have helped me so much
Usually in usa if someone has dirty emg they are sent to neuromuscular and than to als spelacist. They really don't make the diagnosis based off one bad emg
Because my neurologists have said a bad emg could mean do many other diseases that are either curable or nothing major
Thanks again
Thank you for getting back.
Yes, it is very unusual for you to have ALS, based on your symptoms and EMG reports so far.
Spontaneous activity is what we see when the needle is inserted in the muscle. These include fibrillations and fasciculations. In ALS, we see these activities, which are absent in your EMG.
So, it makes me think that the EMG was not done properly.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist
Patient replied :
Ok thank you. So can I take this as a definite no als on limbs or bulbar and move on. And no need to get any other tests?
Thank you so much for explaining. The doctor in pakistan eho performed this had no clue and was lost when I asked him what this emg meant. And he said als and bulbar
I thought to myself that these can't start at the same time rught, you either start with lower motor neurons or upper motor neuron
Thanks again
Yes, you can take it as you do not have ALS, and move on.
There is no need to worry.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist
Patient replied :
Thank you sir. You have helped me greatly. This doctor who did the emg scared me so badly. The information you have provided me he had no clue about
I have asked you a lot of questions on 3 different occasions and you have tried your best to take the time out of your schedule to look over my reports and explained everything
Just one last thought or question
If this emg that showed abnormalities is to be true than my emg that was done in january would have also shown something right
and als and bulbar can't start at the same time right? Als usually starts either with lower or upper motor neuron.
Thanks again
My throat feels kind of tight and when I swallow it's like there is a spitball kind of feeling or sensation. Do bulbar patients who are starting with swallowing issues ever complain of these things?
And if there was something wrong would an egd a barium swallow study and a ent scope study shown something?
I know I am anxious. But you seem to know a lit abd I truly want to just move on
Hello,
No bulbar patients do not have similar throat complaints.
Also, ALS and bulbar do not start at same time.
Please do not correlate these symptoms with ALS. I have assessed and I can assure you, you do not have ALS.
The more you discuss, the more you think about it.
You can move on with your life now.
Regards.