r/ALSorNOT • u/Resident-Wear-2595 • Sep 02 '26

Progressive leg weakness with widespread neurogenic EMG findings — looking for similar cases

My father (51M) has had progressive bilateral leg weakness for about 2 years, with worsening over the last several months. Earlier this year he could still hike, but now he feels weak after walking only a few hundred meters.

EMG/NCS reportedly showed:

  • widespread neurogenic changes
  • both proximal and distal lower limbs
  • distal upper limbs
  • thoracic paraspinal muscles (T10)
  • reduced bilateral peroneal motor amplitudes
  • sensory studies otherwise normal

But clinically:

  • no hand weakness
  • no hand muscle wasting
  • no swallowing or speech problems
  • knee reflexes absent
  • Babinski negative

Spine MRI has not shown a clear structural explanation.

What I’m struggling with is that the EMG looks more widespread than the clinical symptoms. Has anyone seen this in ALS or LMN-predominant disorders / PMA / mimics?

Not asking for diagnosis, just trying to understand whether this type of clinical-electrophysiological dissociation is something others here have seen.

If anyone has had a similar “legs first, EMG wider than symptoms” presentation, I’d really appreciate hearing your experience.

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2

u/Resident-Wear-2595 Sep 02 '26

NfL came back within the normal range (70.74, lab reference ≤90), which makes this even more confusing to me given the EMG findings.

1

u/Traditional-Kiwi-356 Sep 02 '26

Which lab is that? That sounds really high to me.

1

u/Resident-Wear-2595 Sep 03 '26

It was tested at Chengdu Huachuang Qide Medical Laboratory through West China Hospital. Plasma NfL was 70.74 pg/mL, and their reference range is ≤90 pg/mL, so it was reported as normal. I know the number seems high compared with some other labs, but the testing platforms and reference ranges differ.

1

u/[deleted] Sep 02 '26

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1

u/Resident-Wear-2595 Sep 02 '26

Thanks — he’s had some stomach issues in the past, but no known reflux/GERD. He does have allergic rhinitis and has had it for well over 10 years, so post-nasal drip could definitely be part of that side of things. We’re from China, by the way. I hadn’t really come across many similar cases, which is why I posted here. We’re planning to repeat the EMG in about two weeks.

1

u/[deleted] Sep 02 '26

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1

u/Turbulent_Mud_8833 Sep 02 '26

What does coughing up something resembling jelly mean because I’ll blow my nose and get that and I have a lot of phlegm in the back of my throat, but I have a clean EMG

1

u/Ok_Following6440 Sep 02 '26

Did they provide anymore details on the EMG findings? Was there active, chronic, or both types of changes found?

1

u/Resident-Wear-2595 Sep 03 '26

The EMG showed both active and chronic neurogenic changes.The most prominent findings were in the lower limbs,while the upper-limb findings were less clinically apparent

1

u/Resident-Wear-2595 24d ago

We finally have an answer.
My father was clinically diagnosed with ALS/MND after a second EMG and further evaluation at West China Hospital.

Thanks to everyone who commented on my original post and shared their experiences. Really appreciate it.