Hello everybody,

Can EMG/NCV be within norm, with debilitating muscle weakness and still be a neuropathy?

I was looking up a neurologist at a teaching hospital in the peripheral neuropathy specialty, and encountered a very discouraging review from a patient who saw her. This doctor said that if it doesn't show on emg/ncv, there is no neuropathy. Than normal emg/ncv rules out neuropathy. This patient was later diagnosed with some neuropathy...she said that neuropathies should to be investigated along with normal emg/ncv studies.

I find it frightening that someone who's an expert would say that, because as I see patients commenting the same scenerio online, it seems that some have neuropathy symptoms with normal emg/ncv.

Why aren't these experts not looking beyond EMG/NCV?
There must be people on this board who have the same experience?

Any personal insight would be appreciated...

Thanks!

--"experts" should not be saying that.

EMG and nerve conduction studies only measure larger, myelinated nerves. Abnormal results on these do point to some form of neuropathy--at least of those nerves. But these tests will generally only show gross levels of damage, and not right away--it often takes weeks following an injury or disease process to damage the nerves enough for abnormal results to become apparent.

And, more importantly, EMG and nerve conduction studies cannot detect certain types of neuropathy--those that preferentially affect the small, non-myelinated nerves that subsume the sensations of pain and temperature and also control many autonomic functions. These can be detected through specialized types of testing--sudomotor axon reflex testing, qualitative sensory testing, and (the current gold standard) skin biopsy to enumerate intraepidermal nerve fiber density and condition.

In point of fact, the most common presentation of diabetic neuropathy is small-fiber, as is the most common presentation of idiopathic neuropathies. So normal EMG/nerve conduction results in the presence of symptoms should prompt further investigation.

See:

http://www.aafp.org/afp/1998/0215/p755.html

http://www.thecni.org/reviews/13-2-p07-treihaft.htm

I totally agree with Glenn, I have small fiber neuropath (body wide) for a year now, all of my EMG tests are normal.

EMG and nerve conduction studies only measure larger, myelinated nerves. Abnormal results on these do point to some form of neuropathy--at least of those nerves. But these tests will generally only show gross levels of damage, and not right away--it often takes weeks following an injury or disease process to damage the nerves enough for abnormal results to become apparent.
[B]thanks! So if I've had this already for 2 years with "normal" emg/ncv, Does it mean it truly rules out long fiber neuropathy? Or can I still have it?

Could small fiber neuropathy be causing all this muscle weakness and twitching, along with pain increasing in feet over this time?
Emg/NCV said no motor neuron disease signs, the dr says...B]

And, more importantly, EMG and nerve conduction studies cannot detect certain types of neuropathy--those that preferentially affect the small, non-myelinated nerves that subsume the sensations of pain and temperature and also control many autonomic functions. These can be detected through specialized types of testing--sudomotor axon reflex testing, qualitative sensory testing, and (the current gold standard) skin biopsy to enumerate intraepidermal nerve fiber density and condition.

Ok, will work on this one. Whatever I have, began as leg weakness(also shoulder/arms/hands grip to a lesser extent), muscle twitching, cramps/spasms(like charlie horse, in calves), then slowly developing increasing pain in feet. The sensory stuff has been slower to show, aside from pain(I guess that's sensory); slowly beginning to feel a cold burn in feet(usually aware of it when at rest, usually in bed), momentary sharp stinging pains in hands and feet, vibrations when standing on feet.....
Can small fiber neuropathy present like this?
What is sudomotor axon testing?

In point of fact, the most common presentation of diabetic neuropathy is small-fiber, as is the most common presentation of idiopathic neuropathies. So normal EMG/nerve conduction results in the presence of symptoms should prompt further investigation.

I will be pushing, it's just so frusterating and expensive, when does it end
Thank you for your thoughtful information...

--predominantly small-fiber neuropathy would not result in muscular problems--fasciculations, twitching, weakness, cramping--as these nerves do not connect to muscle. It is possible to have "mixed" types, however, or for there to be damage that is causing symptoms that is "subclinical"--not (yet) showing up on the EMG or nerve conduction studies.

There are other things that can cause such things, though--and there are a lot of electrolyte/mineral deficiencies on that list.

Sudomotor axon reflex testing is a small-fiber autonomic test designed to evaluate how well the small sweat glands n the skin are functioning--abnormal sweat response to stimulation can point to problems with small-fiber nerves:

http://peripheralneuropathycenter.uc...ic/qsart.shtml

http://my.clevelandclinic.org/servic..._overview.aspx

I thought I was the only one or going nuts. I had a normal emg and ncv but still having nerve pain and nerve issues. People are saying it is all psychological, but how can that be? I have burning sensation on arms, cannot feel tempt, regulate heart etc...

Why do experts say nothing is wrong with the automatic nerves and other stuff if have a normal ncv and emg reading? I had a car accident months ago and my injuries never quite fully healed.. Now I have burning sensations in arms.. I cannot feel tempt, pain and I have other issues that seem to be related to the automatic nerves, but everyone is saying that is not possible..I was healthy before my accident with no problems whatsoever... Who can I see for these tests? After an injury can nerves tear? AAre you an expert, because the experts I have seen are pretty much saying it is in my head and saying normal emg/ncv there is no neuropathy...I felt a string like thing that goes across your collarbone tear months ago and told people what i felt but stated it is impossible.. I stated I had pins and needles on upper arms and pricking on chest.. When my strain was still present I felt stuff tear on right side of neck and down chest and felt a pop around my belly button.. I told this to the expert and he stated that is again not possible..

If you have symptoms along the collarbone and in your arms, I'd check with our Thoracic outlet forum here... it can be difficult getting an accurate diagnosis of this:

http://neurotalk.psychcentral.com/forum24.html

Check this video out. Its possible you could have sustained an injury to your Brachial Plexus.



http://abclocal.go.com/wabc/video?id...23&pid=8769437

Here's doctors info from that video.
http://www.hss.edu/physicians_wolfe-scott.asp



You also may want to think about getting a MRN done.
http://neurotalk.psychcentral.com/ne...reply&p=914370

if you have small fiber neuropathy an emg/ncv would not pick it up.
skin biopsies to check the number and condition of small fiber nerves (the current standard to test for small fiber neuropathies), quantitative sudomotor axon reflex testing, thermoregulatory sweat test and tilt table tests are testing that can be done to determine if you have small fiber neuropathy.