The Babinski test is properly done on the bare foot. It can be done with very thin socks, but that's a little irresponsible. The stimulus applied is to be "noxious" that is, it's supposed to be very uncomfortable (not a tickle) and that much pressure with a fairly sharp object would likely tear the sock. Many doc's do not do it properly.
The reaction of the great toe in a negative test is to curl or move slightly downward. No movement at all is also considered negative. A positive Babinski is when the toe pulls upward, even slightly. It has to be distinguished from the reflex to withdraw the foot away from the abnoxious stimulation. If you watch very closely, in normal people who pull their foot up and away and their great toe also comes up, it does so AFTER an initial brief move downward. The neuro has to be watching for each subtle movement.
A positive Babinski inidcates a CNS problem, and is consistent (but not diagnostic of) MS.
The neuro who examined me did it with socks on, and it was hardly a rub, let alone a strong stimulus!
The new neuro I saw didn't test babinski, just the other reflexes using the rubber hammer... but that's ok... at least she didn't pretend to do anything like a full examination... and was more concerned with the history, the MRI and the neuro test results...
Seems many neuros need to go back to basics.......
My evil neuro did it hard right down the middle of the soles of my feet. I had no response. My World's Most Attentive Doctor did it ever so slightly with an instrument which was fairly pointed but did not hurt on the sides of the bottoms of my feet. Even that soft touch elicited the Babinski's reflex he was looking for. He did it a couple of times on each foot to show his student, who was pretty excited. I, of course knew what it meant.
Thank you for the responses to my question on this. They only confirm in my mind that I went to the wrong neuro. She may be a good doctor in some cases, but but not mine.
She is either very sloppy, had her mind made up about me already, or just didn't care to put any energy into helping me. : (
I didn't mean to imply that the test should hurt, but the stimulus should be one that you would naturally withdraw from. For people with a VERY + test, a lighter touch with a pointed instrument will show it well.
And yes, Zilla, the dufus didn't even know where to run the pointer.
Em - doing the Babinski right takes a lot of practice. And reading the sublties of the response also takes some training. Often the slight downward motion happens very early in touching the sole.
Yes, you're right. It sounds like a lot of docs don't know how to do it. My new doctor knew exactly where to scratch with his pointer and got what he wanted every time. It was at the end of my long time with him and I was well worn-out. Out of four docs I have been to, I think only the last two have done the test. Maybe I just don't remember.
Is it done only to test for CNS damage or disease? Is it the acid test for MS? I know it also is listed for ALS and a few other recognizable diseases. Is this why Babinski is not part of the standard neuro exam?
My understanding of Babinski in MS is that its not definitive, just an indication, a slight tell that can add to the body of all the symptoms. Also they might do it from time to time to simply make a note of where you are. Same with reflexes. Being Hyper reflexive (exaggerated reflex) is an indication of damage in the brain. Becoming Hypo reflexive (no response) means even more damage in the brain.
Don't trash your Nuero because they didn't do it, correctly or not, its not the acid test of MS.
Yours is a good voice of fairness and reason, as always, but I respectfully differ on the importance of doing this test and doing it correctly. In the setting of the kind of complaints that suggest myelopathy (disease of the white matter of the nervous system such as MS or ALS), the Babinski should be performed in both a thorough (and basic) exam, at least initially. And by a neurologist it should be done correctly. Done half-heartedly through thick socks and then saying it was "negative" is sloppy and incompetent. This test being positive could mean the difference between a prompt diagnosis (finding a clinical lesion) and delay with further testing.
As a test, the Babinski is but a small indicator. You are absolutely right. There is NO test on physical exam that is diagnostic of MS, whether it is positive or negative.
Please do not take this as a rebuke, but a difference of opinion. Quix
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