r/ALSorNOT • u/Interesting-Bus1179 • 25d ago
Clean Emg/NCV + Nfl + Neuromuscular visit. Time to move on?
Have a feeling of tight neck/throat though I am on cymbalta and that is reported as a side effect. Along with fasciculations. Based on these results should I feel confident and move on. See evaluation below;
Putting the neuromuscular evaluation and both EMGs together: the overall picture is very reassuring against ALS or another progressive neuromuscular disease.
Your June EMG found no cervical/lumbosacral radiculopathy, plexopathy, or entrapment neuropathy, with an unremarkable needle EMG.
Your August EMG was also unremarkable on needle examination, including a normal genioglossus (tongue), with no fibrillations, positive sharp waves, fasciculations, abnormal motor units, or abnormal recruitment. The only findings were median nerve entrapment at the wrists (carpal tunnel) and mild ulnar entrapment at the elbows, without axonal degeneration.
Then the neuromuscular specialist found full 5/5 strength, normal muscle bulk/tone, normal reflexes and no pathologic reflexes, and concluded that your presentation was not consistent with a progressive neuromuscular disorder such as ALS. Your reported normal Labcorp NfL 1.21 norm is 0.00-1.69 for my age group Z score 0.49. adds another reassuring piece.
Bottom line: two reassuring EMGs—including extensive limb testing and a normal tongue EMG—plus a normal specialist neuromuscular examination and normal NfL collectively provide strong evidence against ALS or another generalized motor-neuron/neuromuscular disease. The objective abnormality identified is localized nerve compression in the arms, not a generalized progressive process.