What good would an EMG do?

[CAT1962]

I have SJS (SSB), and I was referred to a Neurologist BEFORE my recent DX of SJS. For a weird spell that happened a couple of yrs ago (didn't know where I was or how I got there for several seconds in a  Walmart store...), and silent migraines, the Neuro guy is doing an EEG next week to see if I had a seizure as well as an EMG because I mentioned some tingling in my feet and hands. Has anyone here had an EMG?? Does it help DX anything along with the Sjogren's? Thanks, everybody...

CAT

[Scottietottie]

Hi CAT 

My understanding is that an EMG can read normal if it's small fibre neuropathy that is causing the problems and that a small fibre biopsy may give more answers. However - I'm not medical - and I may have that wrong.

I know I get pins and needles on a pretty regular basis but that any EMG I've had has always read normal. Tests are worth having to rule things out as well as in though.

Take care - Scottie 

[CAT1962]

Thanks so much, Scottie...I am also concerned about the cost of the test. We have good insurance, but just curious. Thank you again! 

[Carebear]

Hi CAT,

I had an EMG, which turned out to be was normal.  As Scottie mentioned, the EMG cannot detect all types of neuropathy.

EMGs can detect abnormal electrical activity of muscle that can occur in many diseases and conditions, including muscular dystrophy, inflammation of muscles, pinched nerves, and peripheral nerve damage.  The test many of us with nerve involvement would benefit from, is the skin biopsy.

I get "lost" a lot myself.  And I have recently had a blackout resulting in a fall.  But both EEGs I had were normal too.

I hope you get some answers.

[CAT1962]

Thank you, CareBear. You know, the Neuro said I MAY have Carpal Tunnel...duh..computer hog that I am!  So, if he is just testing for that, I don't care to pay for something I already know.  hehe. I'll ask him before the EEG next week. That will  be fun with my chronic fatigue...go to bed at 11PM or later, and be up by 4AM or earlier!

[puccini914]

I had a EEG and an NCV and an MRI all in one day.  The sleep thing was terible.  I couldnn't go to bed untl 12 a.m. and had to be up by 3a.m.  The place was an hour and a half away, so I had to be on the road by 6am.  They did the EEG first ad told at one point it was okay if I fell asleep.  No problem!!!  Then the Nerve conduction test that I had heard could hurt a bit, slept through that too and when they took me to the MRI (which always leaves me with a head splitting migraine) I fell asleep in the tube with all the lights and noise.  They had to wake me up to put the contrast in.  Back in he tube and right back out.  When I was done, all I really wated t do was roll over ad go back to sleep.  Thank God my Mom was with so we wouldn't g off the road, but I still had to drive because she's afraid of mountain roads.  AAAHHH the price ou pay for living in a secluded mountain paradse, it does put you 1-2 hours from any modern day medicical tests.

Peace be with you.

Jennifer

[irish]

cat, I had the EMG done to rule out carpal tunnel and I had it. I knew I did, but I wonder if insurance companies want the test done before they approve surgery. It is an elective surgery I would think unless it is really bad and losing feeling in fingers and dexterity of hands.

I have it in my left wrist (had right surgery done 6 years ago) and I know what is going to aggravate it. I wear a brace to bed and it improves. With my right wrist it got so I had to wear the brace much of the time and I still had problems. Irish

[Carebear]

Hi CAT,

Just another thing to ponder...Carpal tunnel syndrome occurs frequently in people who have Sj?gren?s syndrome associated with rheumatoid arthritis.

[navydad]

I;m sure Inga will come along and answer some more,, but I had so many EMG;s done that I swear I still have needle marks in my limbs,, and EVERY time they would come out normal,, and then the frustration sets in when you kow that something is wrong,, it wasent until I had a punch biopsy done that it showed Small Fiber Neuropathy,, EMG studys test for problems of the large muscle fibers,, the ones that let us walk without falling and a lot of other things,,

I dont kow whats worse,, smalll fiber or large,, with the pain of small fiber,, its miserable,, not being able to use your limbs to well,, the constant pain,, problems with temperature,, any Neuro that is worth his license and paid attention in med school should be able to at least narrow down what nerves are being affected if only by the symptoms you give them,, but a lot of them just dont get it,,

[Shani]

My Polyneuropathy got diagnosed based on symptoms.
The Emg turned out to be normal.
It's just about having a real great Neurologist who believes you and wants to help you.

I hope your tests go ok and that you'll get more answers.
Gentle hugs to you!

[inga]

Navydad, I think every one answered the question just fine, without my input....eh, but I can't resist.

I add only this:  Make sure they don't tell you that you do not have neuropathy because your EMG is normal!  You can have severe small fiber neuropathy and the EMG be perfectly normal.  If you suspect PN, and I would, you can ask for a 'skin' biopsy for PN.  Official name:  Intraepidermal Nerve Fiber Density Biopsy.

That said, an EMG could find impingement and other kinds of neuropathy, worth having if insurance pays for it.

[Carebear]

Inga,

Thank you for the official name for the skin biopsy.  Tell me, who typically will conduct this test?  Is it the neurologist or do I need to go to another "ologist"?  Thanks in advance.

[inga]

A neurologist will order it and any number of people can do it.  A neuropathologist will read it.  Usually it has to be done at a academic center since it is so specialized to read.  You may be able to get the actual punch biopsy done at any clinic, but they will likely have to send it to a center where it can be read.

They also rule out amyloidosis when they do this.

They usually do several punch biopsies, one at the ankle, knee, thigh and arm.  They may not do all 4, but they should do at least 2.

The problem with just going on symptoms is that many symptoms including electrolyte imbalances such as low Ca and low K can cause parasthesias.  They can infer a lot from these biopsies.

Neuropathy is far more prevalent in people over 50, than in young people.  In a young person, I would think they would do a genetic analysis to see if anything in the hereditary neuropathy realm showed up.  If some one is seronegative it is critical to make sure that they do not have a hereditary neuropathy prior to exposing the individual to toxic drugs for treatment for AI.  There are some very specific neuropathies and myopathies which can run in certain populations.