Abnormal EMG results still waiting to see neurologist

I am a 38 yo male with a hx of diabetes (3years), htn, hyperparathyroidism (resolved 5 years ago), nafld, gerd, asthma and adhd

Height: 68 inches Weight: 210 lbs Medications: Amlodipine VALSARTAN Nebivolol Anastrazole Metformin Rybelsus Tadalafil Nonsmoker

Back in June 2023 was diagnosed with syphilis and was treated with two week course of doxycycline. Had some unusual neurological symptoms, such as change in mental status, loss of balance and leg weakness during and immediately after antibiotics course. Also had hyperreflexia in knees. Also noticed some twitching, slurred speech, and hearing loss.

Was admitted to hospital in July 2023 and given LP and 4-5 days of IV Penicillin G while waiting for LP results. MRI brain was unremarkable. Also did testing for myositis which was negative. CSF VDRL was negative so they determined I did not have neurosyphilis and sent me home. Was told it was possibly disk herniation or could be neurodegenerative condition and to see neurosurgeon and neurologist. Had MRIs of entire spine.

Cervical: mild stenosis C4 through C7. Moderate stenosis on left side C6-7

Thoracic: T7-8 left disc protrusion with mild stenosis

Lumbar: L5-S1 broad disc bulge abutting nerve roots

Neurosurgeon looked at it and didn’t think anything spinal was causing symptoms and passed me off to neurologist.

Had lower NCV/EMG on upper and lower extremities (in two different places) while waiting the 7 months to see a neurologist. Lower extremities were normal.

Upper extremity reported the following:

NCV & EMG Findings: • Evaluation of the Left median motor, the Right median motor, and the Right ulnar motor nerves showed prolonged distal onset latency and reduced amplitude. • The Left median sensory and the Left ulnar sensory nerves showed prolonged distal peak latency and reduced amplitude. • The Right median sensory and the Right ulnar sensory nerves showed reduced amplitude. • All remaining nerves (as indicated in the following tables) were within normal limits. Impression: Sensory nerve stimulation demonstrate diffuse sensory axonal and demyelinating neuropathic process bilateral and asymmetric. Median motor nerve stimulation demonstrate asymmetric increase in conduction velocity bilateral at the distal stimulation and reduced amplitude. Bilateral proximal conduction block with significant impairment of amplitude bilateral. Ulnar motor nerve stimulation demonstrate bilateral severe sensory axonal and demyelinating neuropathy. No response on the right side at the distal and proximal stimulation. On the left side, the distal amplitude is reduced but present but proximally no response with maximum stimulation. Needle EMG findings demonstrate diffusely reduced amplitude but no evidence of any definite insertional activity. Electrodiagnostic study findings demonstrate bilateral diffuse sensory axonal and demyelinating neuropathy. Bilateral median motor nerve conduction delay across the wrist suggestive of distal compression neuropathy/carpal tunnel syndrome worse on the left compared to the right and severe conduction block proximally bilateral. Severe ulnar axonal and demyelinating neuropathy bilateral with no response on the right and no response to maximum stimulation on the left at the proximal stimulation. Pattern and severity of neuropathy consistent with chronic diabetes. Compression neuropathy often a common scenario in patients with chronic diabetes. However, any decompression intervention may not resolve the symptoms completely. Details of nerve conduction study findings will be discussed with patient and further intervention options to be reviewed based on clinical symptomatology.

Any ideas what I’m looking at as far as potential diagnoses? Does the EMG narrow it down to some diagnoses being more likely? I haven’t been given any ideas other than could be “spinal or neurodegenerative”.

I hate waiting and hope I will get some kind of answer soon, but so far I have nothing. Fortunately, I haven’t noticed any substantial progression of any symptoms, but I worry that with the elimination of the spinal diseases, it could be something worse.