Determining Axonal Damage Using EMG Results
July 11, 2015 at 8:33 pm
Can anyone shed light on which parts of the EMG results may indicate axonal damage? My mother is being treated for her fourth relapse this year. She is very, very ill. I don’t think her doctor is being very forthcoming about the level of axonal damage she has, only that there is damage to the axons and it will take a “long” time for the nerves to regenerate. I have seen reports of axon damage taking up to three years to recover. I think it would help her to know this. I’d at least like to know if the axonal damage is minimal, moderate or severe. He says this can be determined from the report but he won’t interpret the results in this way. He just keeps saying “a long time.” She has been suffering acutely now with Consecutive relapses for over six months, with good initial response to plasma exchange, no response at all to IVIG and diminishing positive response to PLEX in subsequent treatments. She’s now on her first course of steroids and her Cellcept has been increased.
Mom is a tough lady and can handle bad news. I think she would benefit from straight talk. I’ve got a copy of the EMG and will gladly research every velocity reading and latency difference if necessary. Hoping someone here can point me in the right direction. Thank you!
July 12, 2015 at 2:39 am
A doctor can know at a high level of accuracy of the examination
The extent of the injury within the exons.
Offers to take the test results to show to another doctor.
July 12, 2015 at 9:28 am
Thank you, Eldad. I appreciate your response. I think her doctor knows from oblique references he’s made, but at this point we really need someone to level with us so that we can help her make some decisions about living arrangements. She’s 71, lives alone, bought a new condo last October w a large mortgage and has needed 24-hour nursing care to live there for the past 2 months (after her third discharge from rehab since January). If she has a high level of axonal damage and may be facing years of intense therapy and treatment to be able to live independently again (provided a new treatment plan keeps her out of relapse), she can’t afford to keep her condo. She’s a strong, practical woman (30+ years as a social worker) and responds well when faced with bad news. She also gets the feeling he’s holding out false hope. We’ve already seen Peter Donofrio at Vanderbilt for a second opinion (he did the latest test). While that was immensely helpful, as it confirmed the diagnosis and got her a new treatment plan) I still don’t think anyone has really leveled with us about the extent of axonal damage. She’s gone a long time without the correct treatment. We have high hopes for the new treatment plan. It would just be so helpful for someone to say, “Look, there’s enough axonal damage that you could be looking at 1-3 years of treatment and therapy to be able to live alone.” Then she could decide whether she can continue to keep the condo or look at assisted living.
Thanks again for your response. Thank you also to anyone who has additional advice.
July 12, 2015 at 9:54 am
July 13, 2015 at 5:32 pm
It isn’t necessary for you to know how to interpret EMG results, which a layman can’t do anyway. A neurologist should be able to evaluate axonal damage from the EMG results, and should explain it to the patient. If you are not getting accurate and sufficient information from the neurologist, perhaps you do not have the best neurologist.
What a laymen can evaluate is the degree of recovery just by going through the experience. Myelin damage can be repaired quickly, provided the attack on the nerves can be stopped. In my case, I could see improvement daily during the early phase of my recovery. Axonal damage takes longer to recover from, and complete recovery may be impossible. Generally, in three years, most recovery which is possible has been achieved. I know I have axonal damage from the EMG results, and after three years my further recovery has been negligible. I accept that I have permanent residuals.
July 13, 2015 at 5:39 pm
By the way, your mother’s treatment is similar to mine, except that my treatment with prednisone and Cellcept started right after my plasma exchange. IvIg did nothing much for me, either. I don’t understand why there was so much delay in using drugs for your mother.
May I ask how many PE treatments she had, initially? Five is common, but I had nine. I think the number is largely determined by what the insurance company will pay for. This is a problem, because more is better. One treatment is not 100% efficient, so every subsequent treatment in a series increases the reduction in the components which are removed by the treatment. In my case, the treatment was effective. I have had no signs of relapse four years out of the hospital.
July 13, 2015 at 6:58 pm
You say that your mom has gone a long time without the correct treatment? How long?
Axonal regeneration and muscle tissue recovery are time dependent. And, of course, recovery is reliant on the damage causing insult being stopped. Most cases of CIDP are unique. Treatment may need to be on-going.
Here is a partial answer to your initial question: “At the point of injury there will be either focal slowing or a sudden change in the waveform configuration. A good-quality EMG report should always include the actual waveforms of sensory, motor, and F wave tests. This is in addition to the numerical data that are usually included. The exclusion of this prevents a more complete interpretation of the report.”
You may read all about it here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504120/
On the other hand, I know from experience that fasiculations are observable and do not require any testing. Fasiculations can be an indicator nerve damage.
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