Status
Not open for further replies.

juliesmile

Active member
Joined
Feb 20, 2008
Messages
60
Reason
Loved one DX
Diagnosis
03/2008
Country
US
State
CA
City
Borrego Springs
I've been picking up things here and there on this forum and I have a question on reflexes. In my husbands first exam with Neurologist, the Dr. notes that "Reflexes are A+ with the exception of left ankle jerk, which is absent." Then when we went for exam with 2nd opinion Dr. he said he wanted an MRI on his upper spine because although it wouldn't explain the foot drop it might account for the "Brisk reflexes". Both exams show toes downgoing with the Babinski test. Can someone clear up what this might mean. I read here somewhere that reflexes are brisk in ALS and absent in neuropathy. Can you have both. Or is ALS just a form of neuropathy? I'm confused.
 

Marjorie R. Wilcox

Senior member
Joined
Nov 21, 2007
Messages
660
Diagnosis
10/2007
Country
US
State
New York
City
Richmondville
reflexes

Rick has both brisk reflexes and absent ones. He was initially diagnosed with neuropathy and then after the EMG and blood tests, he was given the DX of familial ALS.
 

tmasters

Senior member
Joined
Feb 19, 2008
Messages
531
Reason
PALS
Diagnosis
08/2008
Country
US
State
California
City
Anaheim
Hi Julie,

I'm not a doctor but I've done some research on this. This gets a little complicated.

In ALS there is a slow dying of both the "Upper Motor Neurons" (UMN) and "Lower Motor Neurons" (LMN). ALS is different in different people. In some cases UMN are the first to go, in others it's the LMN. To make a "clinically definite" diagnosis of ALS, the neurologist must detect both UMN and LMN symptoms in a few regions. This doesn't happen until the disease has progressed pretty far.

Your doctor was looking at reflexes because heighened or "brisk" reflexes are one of the main symptoms of UMN deterioration. Sometimes LMN shows a decreased reflex, but a more common symptom of LMN is muscle weakening and wasting.

Bottom line is, it doesn't tell you much by itself, but has to be understood within the context of all the other symptoms that the doctor is looking for.

-Tom
 

crystalkk

Very helpful member
Joined
Sep 11, 2007
Messages
1,210
Reason
Learn about ALS
Country
US
State
pennsylvania
City
philadelphia
julie,

Toes going downward is normal. If he had the babinski the big toe goes up and the rest of the toes go up and fan out. It is another UMN sign.
 

juliesmile

Active member
Joined
Feb 20, 2008
Messages
60
Reason
Loved one DX
Diagnosis
03/2008
Country
US
State
CA
City
Borrego Springs
Hi Tom,

Thanks, it does get confusing. So let me see if I get this right. If my husband has atrophy in his left leg and an absent left ankle reflex, that might indicate some LMN issues. The brisk reflexes might indicate some UMN issues. The downgoing Babinski is a good sign though.
 

tmasters

Senior member
Joined
Feb 19, 2008
Messages
531
Reason
PALS
Diagnosis
08/2008
Country
US
State
California
City
Anaheim
Julie,

I just re-read your original post and I may have mis-lead you if you interpret "brisk" and "normal" reflexes as the same thing. The UMN symptom is actually heightened or exaggerated reflexes. This is what I thought you meant by "brisk" but now I'm not so sure since you also say "A+". If Steve has normal reflexes I would think this is a good sign also, not an indicator of any UMN decay.

-Tom
 

juliesmile

Active member
Joined
Feb 20, 2008
Messages
60
Reason
Loved one DX
Diagnosis
03/2008
Country
US
State
CA
City
Borrego Springs
Tom,

Actually what I was saying is that on our first visit in Oct. Dr. noted Steve's reflexes were ...

"A+ with the exception of left ankle jerk which was absent" Does this mean at this point (Oct>) his reflexes good?

Then our 2nd opinion Dr. (Jan) his reflexes were "Brisk"

He seemed to go from A+ to having Brisk reflexes is a very short period of time.

I guess that's not really a question. Just an observation. Your explaination earlier was what I was looking for.

Thanks
 
Status
Not open for further replies.
Top