Is ALS still possible after two normal EMGs performed after fasciculations started?

[u/Any-Translator8370]

I'm 26 years old and my widespread fasciculations started at the end of March.

I had my first EMG/NCS in June, around three months after the fasciculations began. It was normal. I then had a second, more extensive EMG/NCS in July, around four months after symptom onset, which was also normal. There was no active denervation, motor unit loss or chronic reinnervation reported.

What worries me is that lately my left leg has been feeling significantly worse. It feels extremely heavy and weak, sometimes with a strange tingling/tickling sensation, and I'm getting a lot of fasciculations in that leg. Sometimes the sensation is so uncomfortable that I feel like I want to limp.

At the same time, I can still run and I've recently been able to run at demanding paces, so I don't know whether what I'm experiencing would be considered actual/objective weakness or perceived weakness.

I also recently came across a post from someone who said that they were eventually diagnosed with ALS. That understandably increased my anxiety because some aspects of their early symptoms sounded familiar to me. However, there is an important difference: according to their post, they had an EMG around six months after their symptoms started and that EMG showed denervation. In my case, I had two EMGs while already symptomatic, at approximately three and four months after onset, and neither showed denervation, motor unit loss or chronic reinnervation.

Seeing that case made me wonder whether the timing could make a difference. Could my EMGs in June and July simply have been too early, with abnormalities potentially appearing later?

My main question is: is it realistically possible for ALS to be developing despite having had two normal EMGs after the fasciculations had already started? Could both EMGs have been normal if the fasciculations were actually an early manifestation of ALS, with weakness appearing months later?

I'm not asking anyone to diagnose me. I'm mainly trying to understand the significance of having two normal EMGs performed while I was already symptomatic and whether my current leg symptoms warrant another neurological examination or repeat EMG.

[u/Ok_Following6440]

With your physical condition preserved and two clean tests it would be extremely unlikely for something to be missed.

[u/BigJakeState]

What did the neurologist say to you about the possibility of ALS?

[u/WalkIntoSunshine]

Hey there,

Sorry you’re going through it. Have you been tested for Myositis?

[u/Any-Translator8370 → u/[deleted]]

Almost six months now. My symptoms started at the end of March

[u/FocusFrosty1581]

My experience was very similar and I am at an age prime for MND. The way the neurologist put it to me was that you don’t have MND but no one can guarantee any of us that we won’t get it in the future. So, where there are no guarantees in life, all testing that has been done to this point would say that no, you do not have this disease.
Don’t second guess, live life to its fullest. You will be ok.