Is a Babinski's sign always present in PLS?

I was reading that Babinski's sign is one element of a PLS diagnosis. Is it always present in PLS? I don't think they found this sign in me when it was last done. Would that rule out a possibility of PLS?

Paul

NO I don't think it's always a sign. My mom's doctor report said it was not present but she was diagnosed with ALS (well her's was Bulbar onset though). Not sure if you have limb onset if you will always have Babinski.

More and more doctors are looking for something other than the Babinski sign to determine UMN trouble. They look for Hoffman and jaw jerk to name a few. I have learned that progressive weakness is more key to a diagnosis of PLS. Atrophy and weakness are 2 of the most important keys to a diagnosis of ALS and twitching just doesn't mean a thing if not accompanied by those 2.

Zaphoon

that is a difficult question to answer and depends on progression.
if you start with leg onset pls then the hoffmans sign or jaw jerk may be ok,likewise bulbar onset pls you may have jaw jerk but babinski sign is ok.

pls as in als starts as limb or bulbar onset and spreads.
umn desease gradually spreads up or down the cortical spinal tract.

for instance my progression started as leg onset but over several years it has spread upwards to bulbar a couple of years ago.
weakness follows after each area effected and is also progressive.

I have looked up the Hoffman's sign and jaw jerk reflex. I am pretty sure neither of these tests have been carried out on me. I have had numerous neurological examinations, and would seem that none of the neruos follow the same procedures. The examinations have been less detailed the longer I have gone on in my illness. Again, this makes me wonder what they may have missed.

Paul

Paul,

You can request copies of your reports from the nuero.
Sometimes they do everything so fast, you do not even realize what they have done.

Paul,
like Crysal said you sometimes do not notice test's that they are performing. You do not have to show postive Babinksi for a PLS or ALS diagnosed. it is just part of the entire picture...

Zaphoon is so right...weakness and definite atrophy along with the twitching are the key things....everyone zeroes in on the dreaded twitches!
I think Olly makes a great point...I was limb onset and had a positive(if you can say it that way) Babinsky sign right away and still have no Hoffmans or Jaw jerk and practically no Bulbar symptoms 18 months in....legs are gone tho and arms going fast
Hoping is right on the money....this disease has so many faces that you can not jump to conclusions! You need to look at the movie, not a snapshot to get the whole picture!
Rick

I agree about the how quickly neuros can check for some of the reflexes, you may not have even caught that these signs were being tested. Like Caroline and Rick said, it does kind of seem to spread up or down... depending on where onset is maybe (?) I had jaw jerk from the very first exam, (but only know this from reading my reports) have no idea if I have Hoffman or not, did not have the Babinski at first, but eventually did.... btw, I don't think that the jaw jerk is actually a bulbar reflex, it originates from the trimengial (5th) cranial verve.

Rose you are correct that Jaw jerk is a UMN response...

Rick,

I like your comment regarding taking in the movie verses looking at a snapshot. I didn't start to get alarmed until things were so noticeable that a friend of mine that is a nurse suggested I may have some kind of neuropathy.

Some folks that we've had on here daily check their tongues and perform other mini-neuro exams on themselves. I find this fascinating and have vowed not to start looking at my own tongue, count the number of fascics I may have per minute or measure the circumference of diverse body parts. Heck, it can be enough just to walk up stairs or get off the pot!

Cheese!

Zaphoon

:lol::lol::lol:kim you are just hilarious sometimes.
i do really admire you,you are always so positive with a great personality .
just for you i may try a brown mushy banana spread sandwich,i mean TRY.:grin:

Theres only one test that seperates ALS From PLS ,its Called EMG or Electromyography as most know this is going to show if the nerves are dead or not ,or if their getting a signal ,all these others are not really deffinitive like EMG . So dont put it off . My geuss is if you have fasics in the Tongue and you get a rumpled look to the Tongue . The rumples indicate that musclle tissue is dieing otherwise the Tongue is smooth somewhat . One test for tongue strength is push the tongue into the cheek and have someone see if they can push your tongue in . If the tongue is weak you wont be able to hold any pressure on it . Another good one is have someone hold out two fingers ,you squeeze them hard ,if you have strength ,they will know . If your Spastic in some movements this may have some effect but no much ,strength is strength
theres all kinds of Motion . Fast repetitive , is one ,this is where spasticity shows up ,squeezing is another type ,this is just brute strength.
Some people think because their spastic their weak ,this is not true . Another test is to stand at the Kitchen sink grab the counter and do a squat ,then come back up , do a few of these to make sure your legs can do their job . Now do these slow because if you try these fast Spasticity can affect them . Spasticity to me is the inability to do something repetetively in a coordinated manner or incoordination . Have someone help that can handle your weight . because if you fall you'll need help getting up. Geo

The problem for me, when it comes to neurological examinations, is that for the past 2 years the neuros have treated me as if I have no neuro symptoms and have a conversion disorder instead. This means they rarely actually do a neurological examination, and I know enough to realise when they do, they only ever do a cursory one. I do not have a diagnosis for PLS, but I know that whatever it is I have it is still progressing.

My symptoms started with problems with speech although I didn't mention this when I first saw a neurologist as I didn't realise it was significant at the time. My voice would become weak and hoarse sounding, but I didn't have a sore throat. This would last for a week or two and then go back to normal and reappear again later. My speech is now almost always hoarse, weak and disjointed. Speaking takes a great deal of effort, I can feel the muscles tightening in the side of my face. The muscles in my neck and throat sometimes go in to spasm and it feels as if I am being strangled. I have had swallowing problems and have had some problems with aspirating.

I have myoclonic movements of my head and upper body, my head sometimes being thrown back, at over times turned to one side. Some times I have a few of these a day, other times I can have as many as 3 a minute (fortunately this only rarely happens!).

My legs feel as if they are going in to spasm when I try to walk. It isn't always immediate, usually after taking a few steps. My calf muscles feel as if they go into a tight ball, and after a while my right foot (my right side is worse than my left) does move properly, I am walking on tip toes unable to put my heel down first. There seems to be some weakness in my right leg, and I use a stick as I drift to the right. Any tendency to fall is to my right. Standing still for any length of time is particular difficult. my gait is also 'tremulous'. My balance isn't good. But when I am examined it would seem the spasms and weakness do not show up. They suggest there is no loss of power in my legs. The spasticity I feel in my legs when walking doesn't seem to be evident in them when I am lying down being examined.

In recent months the problems have moved to my hands. Holding a book, for instance, is difficult and I quickly need to support my hands. My fingers twitch and move on their own. Writing is difficult as my hand cramps very quickly. I cannot bring each finger, on my right hand, to my thumb repeatedly without my hand seizing up. I get muscle twitches in my legs and hands, I can see the muscles rippling under my skin. They are not constant, they come and go. I am aware that compared to many of you I am quite well. But I can see myself slowly getting worse.

I have tried doing some of the tests on myself, babinski, pronator drift, hoffman sign etc. Not really a very good idea as i am not a neurologist and hardly objective. The pronator drift sign and the hoffman sign do seem positive. But as I said, i may be doing them wrong!

Thank you all for answering my question about the Babinski sign. I do think I need to try and get my notes, if nothing else to see what the neuros have written about me. I do some times worry about coming on forums like this, because I may be barking up the wrong tree! I notice that I am not the only one here who has no diagnosis.

Best Wishes,

Paul

My Video Blog

hi paul.
we all share some of the symptoms you have ,i can identify with a lot of them.
many come on here with "umn and/or lmn"symptoms and no diagnosed.
they can identify having similar problems and find comfort and support till they get there diagnosed.
so if we can help in anyway we are always here.

personally, i would ask to see your hospital file.
you have to go to your gp and it may take a few weeks plus i think theres a £10 fee.
i was going to do this some years ago as i felt they were not telling me everything,but my gp said they can ommit anything in your file that they feel may cause distress.
you have to be firm,we have a legal right to this information.

i totally understand what you mean about the neuro,s and the exams.
at my mnd clinic appointment a year ago the neuro there was not very nice.
he did a brisk exam and disregarded some of things my own neuro(a respected old proff)had noted.
my mum said he was just reading randomly from my notes and it was not making sense.
he even said that pls would show on a mri but my mri was normal!.

i got testimoneys from many with pls and some neuro,s saying mri,s of those with pls are normal and sent them to him.
well lets just say from his reply letter he was not happy being proved wrong and shown up. i dont care,i was not having a jumped up imbocile treating me like a idiot.
my neuro after following my progression for some years and ruling things out says it is pls/umn desease.
i have not been back to the mnd clinic and never will.

there are many others who have the same problems with neuro,s so you are not alone.

if we can make you feel better in yourself with support then please stay,i would hate to think of you out there alone with all this.
we are all in this together