Can an EMG Diagnose PPS ?
Original Post: I understand an EMG does not diagnose PPS but is a test used to eliminate other potential problems. However, according to two physiatrists I've seen, I do not have PPS based on my EMG results. I had “non-paralytic” polio as a child and was told my EMG did show old polio damage.
I have suffered with worsening PPS symptoms since the late 90s. No one has an answer for my leg weakness and shrinkage or developing scoliosis and leaning to one side. I know I need a brace on my left ankle but who do I go now? I'm feeling totally cut off from any PPS care.
Dr. Bruno’s Response: First, you're right: An EMG CANNOT diagnose PPS !
Many thought in the 1980s that EMG would be THE test for PPS. But not one EMG study could tell the difference between a newly weakened muscle and one that has always been strong.
What’s more, at least 10% of EMGs are negative even in polio survivors who had obvious paralytic polio. An EMG finding of polio damage depends on how many motor neurons were killed, where and how many times the EMG needle is inserted in a muscle and the number of muscles tested.
But your EMG was positive for having had polio, meaning that you DID have motor neurons killed and certainly can develop PPS. So you have didn't have “non-paralytic” polio. You had in apparent polio which is “paralytic polio”. The EMG showed motor neurons indeed were killed, even if you didn't have obvious paralysis or even muscle weakness. As many as 40% of children diagnosed with "non-paralytic" polio had or developed obvious muscle weakness on manual muscle testing.
We should discard the clinical descriptors of “non-paralytic” and “paralytic polio” and replace them with:
“non-neuropathic” (the poliovirus did NOT get into your brain or spinal cord) and
“neuropathic” polio, where the poliovirus DID get into your neurons.
There is a long discussion about this in The Polio Paradox.
Bottom line: PPS is always a diagnosis of exclusion. If everything else is ruled out, and you have PPS symptoms, you should be treated for PPS. Find a doctor who wants to have a conversation and get that brace!
This article: “Non-Paralytic Polio can help.
Look in the Index of the Encyclopedia of Polio and PPS under the topic “Non-Paralytic Polio” for more information.