the SFEMG is normal in some people with clinical symptoms of myasthenia.
no matter if it is done in a weak or strong muscle, no matter if you stop mestinon for a zillion years.

among the MG experts there are two schools of thought-

-there are those that think that patients with clearly evident myasthenic symptoms (to the extent that they admitted to the ICU for them) can't have MG if their SFEMG is normal.

-and there are those that think that it is quite possible (even if relatively rare) to have a completely normal SFEMG and have myasthenia.
some are even ready to think that MG can be caused by an abnormality in the muscle itself, without any abnormality in trasmission of the electrical signal.

the bottom line is that if your MG specialist belongs to those that think it is impossible to have MG with a normal SFEMG, he will not change his mind what ever you do, and quite likely your third EMG will be as normal as the first two.

I think you need to find an MG expert that is more ready to think out of the box, and make the diagnosis based on your clinical picture and not just tests.

unfortuantely most aren't and you just haver to keep on searching until you find one.

the analogy to this would be- let's say you have one arm that is shorter then the other, you will never be able to find a proper shirt, but would have to find an excellent tailor that could make one for you making your arm difference barely noticeable. finding such a tailor may be time consuming and require travel, but you would have no choice.

the misconception with the SFEMG is very understandable. it was assumed that what works for most, should work for all. but, unfortunately this is not so. and you ( and I and a few more people around the world) happen to belong to the group of "very unlikely" patients, but we do exist! and deserve the same care of those that fit the book.

alice