Brisker reflexes

[jethro]

are sign of closer immobility, worse disbalance, muscle deterior or...?
i have brisker reflexes than last time i visited my neuro (3 months ago), my neuro noted. forgot to ask him.

asked him about upper motor neuron, he said can not measure, just clinically.
he talked about ENCALS in GB he attended few days ago.
nothing new. still zebra fish level.

 

[Nikki J]

While hyperreflexia is an upper motor neuron sign I have found my reflexes can vary visit to visit. I have never been really hyperreflexic just brisk but then it will be not even brisk etc.

Sometimes a little upper motor neuron spasticity can actually help if you are more lower motor neuron dominant as a SMALL bit of spasticity can mitigate weakness. This is why treating spasticity can be a trade off. My sister found if she took enough baclofen to knock out the spasticity she had too much weakness. She tolerated some spasticity in the day then took more baclofen for her bedtime dose.

I wouldn’t read a lot into the reflexes especially is they were brisk as opposed to kicking the examiner across the room

 

[Clearwater AL]

In some cases of ALS there can be the absence of reflexes (Areflexia)

It can be found to be somewhat of a consideration in everyday activities. Didn't want
to use the word dangerous...

That's what I have.

Google, get ready... here they come.

 

[KimT]

I've had an absent reflex in my left ankle for several years and, maybe, longer. My reflexes fluctuate. They are always brisk but they always have been.

 

[Clearwater AL]

Hey Kim, last three visits at the ALS clinic (and before) my Neuro did the hammer test
then had the student/intern do it and told them "This is Areflexia, found in some cases
of ALS."

Wrists, elbows, knees and back of the ankle.

 

[Clearwater AL]

I want to add to this... there is a difference between areflexia and reaction reflexes.
That "driving" thing.

Reaction reflexes employ visual and brain response to a situation happening or
about to occur.

From an Email...

Also, my comment above concerning Google. It was not intended for very
knowledgeable and extremely knowledgeable members who would be aware
of this anyway. It was for readers who may often post elsewhere.

I apologize if anyone took it wrong. Should have left it off.

Again, that "driving" thing.

 

[KimT]

I usually close my eyes when they do my reflexes because I don't want my anticipation to throw them off. I often let students "practice" on me.

 

[Nikki J]

One researcher insisted I look at the ceiling during the whole reflex exam. He also said the Babinski is not reliable if you know what it is

 

[Clearwater AL]

There have been incidents and as I recall in a few Threads of past where the posters
said their Babinski test was flat.

It's pretty hard to fake/anticipate a Babinski where your big toe points up and your
toes spread. Or no reflex at all... flat. The bottom of the foot is the most reactive,
when tickled, it responds more than the ribs.

Most Neurologists will drag the bottom of the foot more than once, pause and ask
the patient a question when they try again if they aren't sure.

I guess all "Gold Standards" today fall aside. At one time the Babinski was considered
near Gold Standard.

With the Hoffman test... not every flick on the index finger will produce a reaction
of the thumb. The Neuros know what they are looking for, exactly how the thumb
reacts when it does.

 

[Nikki J]

He didn’t mean someone consciously faked a babinski but rather it impacted/ inhibited the reaction somehow or it might. Same with deep tendon reflex and watching. You are completely right just one test and not one that they seem to count very highly often. It is as we tell the dihals the whole picture

 

[affected]

My father was not a nice man and he used to tickle the girls, when we were children until we were crying. I learned not to react to my feet being touched, so I would probably have to be looking away

 

[Clearwater AL]

Well, tickling is one thing but... having a wooden tongue depressor or the pointed
end of a reflex hammer dragged firmly up the bottom of your foot is another.
The neurologist knows exactly where to drag it... slowly or quickly.
Not too many people laugh during that test.

Researchers are like lawyers... there's always another with a different opinion.

 

[Kristina1]

I have crazy hyper reflexes. Often they go off on accident, like my hand drops into my lap and hits my knee and suddenly my leg kicks up so hard and fast that it hits the table/desk and knocks things around! And it's everywhere- not just legs and arms, but also gag reflex and startle reflex. The startle one is very uncomfortable my whole body jumps violently. It's very weird and gets worse and worse over time which I find odd since I am getting weaker- how are the muscles able to produce that response stronger as they are getting weaker? I don't get it but neuro said it will indeed continue to get worse.

 

[KarenNWendyn]

Kristina asks, “how are the muscles able to produce that response stronger as they are getting weaker?”

Great question. Here’s my best guess.

Each reflex involves multiple spinal nerve roots and causes contraction of many muscle fibers. So there would have to be fairly complete damage to many nerve roots and muscle fibers to lose those brisk reflexes. Even if one can’t walk, for example, there may still be enough remaining nerve fibers and muscle tissue to elicit a reflex, even if it’s not enough to move the joint.

I would be curious to hear from people who have long-standing paralysis if they still have reflexes and/ or clonus.

I can tell you from my experience of working as a rheumatologist that people with fused joints did not have reflexes involving those joints.