Hyperreflexia vs Hyporreflexia

[morleyde]

I have PLS and a lot of Hyperreflexia. No Hyporreflexia. Hyper being upper motor neuron dysfunction and Hypo being lower.

But I often hear people talk about Hyper in relation to ALS. Why is that? Wouldn't ALS be Hypor, or both?
Why is Hyper a sign of ALS? Does it appear before Hypor?
As a person with ALS progresses wouldn't Hypor become the dominant symptom instead of Hyper?
Hyper is just as it sounds, exaggerated reflexes. Hypor is reduced reflexes.
Doesn't a person with ALS have less reflexes as the disease progresses? Eventually no reflexes?
An EMG on a person with PLS is clean. But with ALS it shows bad connections, thus Hypor.

Thanks for helping me understand and get it right.
P.S. I spelled it wrong, it is Hyporeflexia.

 

[KarenNWendyn]

Reflexes tend to become hyper in ALS due to involvement of the brain and lateral corticospinal tracts. This is an upper motor neuron sign.

Hypoactive reflexes only occur from ALS if a muscle is so atrophied that the reflex can’t be elicited. Muscle weakness is a lower motor neuron sign, but that term is not used to describe hypo reflexes.

In a person going through the diagnostic process, hypoactive reflexes point away from ALS. Symmetrical hyperreflexia can be a normal variant. If there is asymmetrical hyperreflexia, that is more suspicious for ALS and PLS. Normal reflexes in an atrophied muscle can actually be viewed as an upper motor neuron sign if there is other evidence pointing towards ALS.

Pathological reflexes such as Hoffman’s and Babinski’s signs are also UMN, as is clonus. Note that none of these are specific for ALS/ PLS.

Keep in mind that what is important when it comes to diagnosing ALS is the big picture: clinical weakness as determined by a physician, characteristic EMG changes in multiple muscle areas, upper motor neuron signs, evidence of disease progression, and ruling out ALS mimics.

PLS is considered a pure upper motor neuron condition. The opposite is PMA which is considered a pure lower motor neuron condition. Reflexes in someone with PMA tend to be normal to hypo. ALS has features of both UMN and LMN. PLS and PMA sometimes evolve to ALS. Some people with ALS are UMN- or LMN-dominant.

 

[morleyde]

Thanks Karen.

I didn't know that hypo was not a normal part of ALS. I thought the weakness was Hypo

Why is asymmetrical hyperreflexia more suspicious for ALS than PLS?

 

[Nikki J]

It is an abnormal finding and suspicious for both ALS and PLS and other neurologic diseases if found with other clinical exam abnormalities ( I think you missed the ALS/ PLS in Karen’s post). What Karen was pointing out was symmetric hyperreflexia is normal Or anxiety. Our worried well poster in Could I have ALS often panic at their brisk reflexes which are normal and even more commonly seen in anxiety.

 

[morleyde]

I have hyperreflexia in both legs and my left arm, but not my right.

When the Doctor taps my knees it looks like I am try to kick him. My left elbow has more response than my right. My symptoms are worse in my left side in general. I notice hwen he taps my left arm the response seems a lot more than the right, Legs are the same.

I have babinski, hoffmans, clean EMG's, no atrophy or weakness.

 

[morleyde]

It is an abnormal finding and suspicious for both ALS and PLS and other neurologic diseases if found with other clinical exam abnormalities ( I think you missed the ALS/ PLS in Karen’s post). What Karen was pointing out was symmetric hyperreflexia can be and often is normal. Our worried well poster in Could I have ALS often panic at their brisk reflexes which are normal and even more commonly seen in anxiety.

Nikki,

You are right, I missed the ASL AND PLS, and thought it was ALS instead of PLS.
Thanks for helping me.
I have often said that when I die and go to heaven, I will ask God why I died of disease X.
He will tell me that I never had disease X.
I just worried so much about having disease X, that I died from worring about having disease X.

Will I never learn?

I am grateful for level headed people like you who are willing to help.

Thanks,
Joe