It's a big problem for me, its either a brain tumour or nothing!
But yeah...ALS isn't subtle. A neurologist has gone through years and years of training to know what a true ALS patient looks like. They will know the subtleties and nuances and they will know that it doesnt come in with sproadic twitching.
They offered the EMG for nothing more than to try and offer you peace of mind that the negative results will ease your fears. In my experience this isnt the case. Hence when I don't think it is worth pursuing the EMG. I would pursue therapy.