However, the single fiber EMG jitter reveals that reinnervation could be detected in the fourth week (increased jitter) after muscle transplant in healthy nerve and muscle fibers. About your point do fascics specifically occur before or after the onset of reinnervation in ALS, I do not know.
Practically, all the patients I have seen got the fasciculation (if present) with other signs of denervation and neurogenic MUPs of variable degree. In one report (letter), 6.7% of ALS patients had fasciculations as an isolated, initial manifestation of the disease (Eisen and Stewart. Yes, I agree that patients with ALS may present with fasciculation. Referring to your answer: in ALS – Do you find fasciculations only when there is on going reinnervation? Isn’t it possible to find/have them during denervation – before reinnervation starts?Īnd if so, I know It is common for people with ALS to have them as a very very early sign – does it mean that when they feel/notice them- they are already in the reinnervation phase (after denervation)? And if so, how come fasciculations are an early sign of ALS (as reinnervation takes place much later) In a study in 1993, a total of 121 patients with benign fasciculations were followed up to 32 years, none developed ALS (Blexrud et al, in Ann Neurol 1993 34:622-625). The decision is made by what kind of company they keep. There is no “infallible” way to tell whether the fasciculating discharge by itself is benign or malignant. Fasciculations may mimic normal or abnormal motor unit potentials (MUPs) as seen in on-going reinnervation. Clinically this refers to visible twitching of the muscle and are seen in the EMG needle examination as fasciculation potentials. No, in ALS (even normal or other conditions), it is one kind of fasciculation. I know that fasciculations in ALS are due to nerve irritation (the same as in benign fasciculations?)- However in one of the posts it was said that fasciculations are due to ongoing reinnervation (the ones seen in EMG) are there two types of fasciculations in als? In my experience, I see the neurogenic units before I see the fascics, or very close to them in time Are there 2 types of fasciculations in ALS? Yes neurogenic units means polyphasic units, later on with high amplitude. * I am asking it because I have read that abnormal motor units (huge amplitude.) are more common with chronic long standing denervation What do you mean by neurogenic potentials? Do you mean neurogenic units – the abnormal motor units (amplitude etc.)? Second, so according to your answer if a person fasciculates for months and It is due to ALS (malignant fasciculations)- His motor units should be abnormal (huge amplitude and so on)? How much time on average does it take from the beginning of ALS fasciculations to the appearance of abnormal motor units (neurogenic units) By the time fascics develop in ALS, you should see a good deal of neurogenic potentials I have read there is a connection (in ALS) between abnormal motor units (large amplitude) and the appearance of fasciculations- which means if there are ALS fasciculations – there will also be abnormal units – Is that true? And if not, how much time would it take for abnormal units to appear if there are already ALS fasciculations? (Weeks, months.)?įasciculations (at least Motor Neuron fascics) are a sign of ongoing reinnervation and can actually begin distally in regenerated nerve fibers.
If the SNAP is abnormal consider a concomitant neuropathy of different etiology or revise your diagnosis to something other than ALS Abnormal motor units in ALS SNAPS or sensory nerve action potentials should be characteristically normal in ALS as the disease affects the anterior horn cell, (Amyotrophy) a motor neuron disease.
While the compound muscle action potential (CMAP) is normal initially, but in advanced disease gets lower (even absent) due to severe loss of axons. The motor unit potential (MUP) gets higher in MND. What is the motor amplitude? Is it pathologically higher or lower than normal in ALS/MND?
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