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Active member
Feb 20, 2008
Loved one DX
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.

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.
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.


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.
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.

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.


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.

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