Abby,

I wouldn't have mentioned this, but as you keep on questioning your diagnosis (which is overall reasonable, as you obviously have some type of myasthenic syndrome, but this doesn't have to be autoimmune MG or MG at all), I will.

The SFEMG has a lot of false positives. (in fact this is agreed by all neurologists, as opposed to the opposite).

After I had numerous negative SFEMGs done by one of the best neurophysiologists, I was seen for consultation by another neurologist who did on the spot a SFEMG of a few muscle and all showed clear cut and unquestionable jitter. I noticed right away that she used a very different technique and questioned those results myself. It didn't make sense that I would suddenly have jitter in every possible muscle after 3 years in which it was constantly negative. And like you, I didn't want to be diagnosed with something I don't have.

I ended up consulting another neurologist, who sent me to one of the best neurophysiologists. Needless to say that my SFEMG was completely negative, and when I showed him the results of my positive test he shrugged his shoulders.

My neurologist recently told me about a patient he saw in his clinic who complained of generalized fatigue, but had no symptoms or signs of MG. She came with an unquestionable diagnostic EMG. As my neuorlogist is an excellent clinician and doesn't diagnose (or rule out a diagnosis) by test results, he sent her for a repeat test to a more experienced neurophysiologist and this test came back completely normal. He said to me-The SFEMG is a very hard test to perform, and it is OK not to know how to do it. Unfortunately, not everyone that thinks he knows how to do it, really does.

This test, in my opinion is very unreliable (both ways) and if your diagnosis is merely based on that, I think you are completely right in questioning it.