Dr. Aida Abaz Quka
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
Answered by
Medically reviewed by
Patient's Query
Hi doctor,
I have had three EMGs in the last 17 months. The doctors say I do not have ALS, but I have new symptoms that correlate with the disease. I was told the last EMG (the other two) were normal, but on the report where the T9 paraspinal was tested, the poly, amp, duration, recruitment, and activation areas were left blank. Those areas have not been tested, but the doctors know about them. Could they be wrong, and why were they just left blank from the report?
Hello,
Welcome to icliniq.com.
I understand your concern and would explain that with three normal EMGs (electromyography), we can exclude ALS (amyotrophic lateral sclerosis). I would like to know more about your symptoms and complaints. There are some specific EMG criteria for ALS that a neurologist knows. But the information is really specific. Damaged nerves should be present in all examined territories.
I hope you will find this information helpful.
I remain at your disposal in case of further questions whenever you need me.
Kind regards.
Patient's Query
Hi doctor,
Thank you for answering and here is the issue. On the third EMG, I explained I was having trouble swallowing. The neurologist said she could not reach the area with the needle to test swallowing, so she tested the 7th cranial nerve instead. About four weeks after the test I was eating lunch and the left jaw muscle went spastic. It was so tight that it took all the strength I had to open my mouth. Since then I have had jaw fatigue when eating. Additionally, about three weeks after that, I had a muscle on the left side of my back get so tight that it put a lateral shift in my spine for two weeks. No amount of ice, heat, exercise, or chiropractic care helped. After two weeks it just went away. I explained this to the neurologist, but they did not examine either the jaw or back muscles, they just said it is not ALS. Also, why were the areas I mentioned on the EMG report left blank?
Please help.
Hello,
Welcome back to icliniq.com.
I understand your concern and would explain that your symptoms are not suggestive of ALS. You should know that ALS causes progressive muscle weakness and wasting, besides involuntary muscle twitching or cramps. The difficulty swallowing is progressive, more prominent with fluids and hard foods. Anyway, I agree with you that the EMG test was not performed completely due to technical difficulties. Considering your symptoms, I recommend checking vitamin D plasma levels for possible deficiency, vitamin B12 for deficiency, thyroid hormone levels, and blood electrolytes. A metabolic disorder, like those mentioned above, can cause muscle spasms. I hope you will find this information helpful.
Regards.
Patient's Query
Hi doctor,
Thanks for answering. I tested my jaw for strength. While lying on my left side, I balanced a 15-pound weight on the right side of my jaw. I then proceeded to lift the weight by shifting my jaw to the right. I was able to lift it to the right as many times as I wanted. When I switched to the other side, I was only able to lift the weight once. Does that not mean muscle weakness, especially with the spastic episode a few weeks earlier? Lastly, every time I walk now, I get muscle stiffness in the left lower back and the left trapezius muscle. Why do you think this is not ALS? A blood test is negative, as is an MRI of the full spine and brain.
Hello,
Welcome back to icliniq.com.
ALS does not have any jaw symptoms. So, regarding your jaw problem, I think that it is more suggestive of a temporomandibular joint dysfunction based on your description. Besides, our body is not entirely symmetrical. It is quite common that the left side of the body is differently strong compared to the right.
Regarding the lower back and trapezius muscle, it could be related to a wrong posture. I recommend performing a physical activity to help reinforce your back muscles. I would suggest some magnesium supplements (300 to 400 mg daily) to help reduce muscle spasms. I do not think that this is ALS, as your symptoms are not typical of this disorder.
I hope you will find this information helpful.
Patient's Query
Thank you doctor,
To follow up on your response, please consider this with an open mind. Two years back, it was confirmed that ALS could be triggered by nerve damage in certain conditions. Six years back, I had a LINX device implanted for reflux management. This device was implanted 1 mm away from the vagus nerve. In these five years, I had it in me, and it caused an electrical shock feeling throughout my body once and several episodes of heart attack symptoms. So much to the point, I checked for heart disease, and there was no heart disease. I started having swallowing problems three years back, and an EGD found that I had a presbyesophagus (corkscrew-shaped) with no explanation.
I removed the device a year. Before six months, I started having swallowing issues again. EGD was fine, but high-resolution manometry found that the esophageal pressures were low (some in the negative range), and peristalsis was poor. My theory is that the LINX has damaged my vagus nerve that set off ALS in the esophagus and has now moved into pharyngeal swallowing and chewing issues. Also, my voice has been starting to lose its tone capability for the last few days. What are your thoughts?
Please reply.
Hello,
Welcome back to icliniq.com.
I understand your concern. I would explain that your symptoms are not related to vagal nerve dysfunction. The vagal nerve dysfunction may lead to cardiac arrhythmia, orthostatic hypotension, loss of consciousness, progressive dysphagia. Do you chock with water? Do you have voice hoarseness? This could be suspicious of vagal nerve dysfunction. Besides, the vagal nerve has different parts (nerve roots), and the one in the esophagus is not the same that controls the vocal cords and the nasopharyngeal region.
I hope you will find this information helpful.
Please let me know in case of further questions.
Wishing you all the best.
Was this conversation helpful?
Same symptoms don't mean you have the same problem. Consult a doctor now!
Neurology
Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.
This website uses cookies to ensure you get the best experience on our website. iCliniq privacy policy
