Oh yeah... no knee reflex!

[jensequitur]

I already mentioned that I had my six month follow-up.  I was tapped, prodded, wiggled, and inspected, and pronounced not progressing... of course, we all know that everybody with MS progresses a little.  But I'm still RRMS, as far as the clinical definitions go.

So anyway, I mentioned my theory about having a lesion in the spinal cord.  He rapped my right knee with a rubber hammer, and there was absolutely NO knee-jerk reflex in that leg.  There was a little at the ankle, and the left knee and ankle work just fine.  He didn't say anything about it, but I knew it was weird.

So I did my usual Google search for information, and found that a total lack of knee reflex is an indicator that there's a disruption of nerves at the spinal column.  The rap on the knee sends a signal to the nerve, which goes to the spine, which goes back to the knee and tells it to kick.  In other words, I probably do have a lesion in the spinal cord.  At least as far as I can tell!  My neurologist was strangely uncommunicative yesterday.  Which I'm a little tired of, but I'm perfectly capable of getting good information from Google, so it hasn't been a problem, so far.

[jensequitur]

Those spine lesions are hard to see!  I hope they can find something this time... it's got to be frustrating.

[monotreme]

I think there would be a spine lesion too.  Because he even has the "MS  Hug"  and paraspinal spasms .   But  maybe they will show up at some point.

Craig needs another brain and spine MRI in May so we'll see.

Elaine

[jensequitur]

Hmm...  And no sign of a lesion in the spine, right?  I got the impression from the texts that the knee-jerk reaction was a no-brainer - that if there is no knee reflex, then the problem is in the spine, not the brain.  I do have a lesion in the cerebellum, on the right.

[monotreme]

No, Craig has not regained his reflexes.  He used to jump if you even got near him. but since last April 2007, his knee reflexes are gone.   And in 2007, he had seven spine MRI's to make sure he had no spinal cord stenosis or nerve impingement.  there is none.  Just absent knee reflexes and lots of other symptoms.

The spasticity in his legs sure has worsened though.  To the point where some muscles and tendons are "frozen".  So I don't think the reflexes have a chance of coming back.

Elaine

[jensequitur]

Elaine, has Craig regained his knee reflexes?  

[amas]

When the neuro did the Babinski on me i didn't know what the reflex should have been at that time but knew he was looking for something.  I was surprised that I did not move at all but when I got the neuros report it said downward going?  Who knows! Anamaria

[monotreme]

Also, absent reflexes for Craig on bare skin.

Elaine

[jensequitur]

Yeah, my tests were definitely on my bare leg and bare foot.  When the doc whacked me with the hammer... Thud!  Just like Zilla talked about.  It hung there like a dead thing, which it isn't, but sometimes feels like it is.  But I often have proprioperception problems with that foot, and when I walk, I feel like I have to swing it forward - so I'm not surprised there was no reflex.

I actually wasn't watching the big toe - I was watching for the fan of the toes, which I've heard about.  So maybe I'll get R to tickle my feet tonight and see what happens... :-)

[Quixotic1]

Yes, absent reflexes can and do occur in MS and yes, they are indicative of a problem in the spinal cord.  They will be hyper in most cases.  But if the damage is severe enough at that tract of fibers the reflexe can be lost.

Babinski - the negative (normal) reaction is for a slight downward movement of the Great Toe (that's the only toe that counts)  I was taught that no response is considered normal or indeterminate.

A Positive Babinski - is an upward movement of the great toe, which may or may not be accompanied by the other toes fanning.  It's the great toe that is watched.  It means there is trouble in the upper motor neuron tracts which may be brain or cord, either.

The Babinski must be done on the bare foot.  A sock is too likely to dull the noxious stimulus and give a false negative.  Beware of the doctor that tries to elicit a Babinski through a sock.

Also, Zilla's doc tried to elicit her patellar response THROUGH her blue jeans.  I know from experience that this will often fail to get an response!!!

Hope this helps.

Quix

[jensequitur]

Also indifferent Babinksi response - which again, I had to look up.  It's the test where the neuro draws a thumb up the bottom of the foot.  In normal people, I think the toes are supposed to curl under.  In people with neuro problems, the toes fan out.  It's not normal for an indifferent response (no movement at all) but I wasn't able to find out what exactly that meant.

[jensequitur]

FluffysMom, you might try visiting BugMeNot.com - they have a lot of passwords to websites that usually require a paid membership.  I found a password for Medscape on there, and it's the usual source I refer to when looking up medical stuff.

I think that as MS progresses, we acquire lesions... when we go into remission, we heal up from those lesions, so some of our function returns.  Of course, we never completely heal up, although some heal better than others.

[monotreme]

Absent knee reflexes must be a common thing.  Zilla mentioned in a post that hers are absent and Craig has had no knee reflexes for a year.  And the back spasms and "MS HUG " too.  

I would have to think he has spine lesions as well.

Elaine

[Fluffysmom]

I still haven't heard from my neurologist about the spine films done a week ago, so I can totally sympathize with getting tired of such things.

When I saw my neuro, my knee jerk was absent at first, but she kept hitting it with that little hammer until it was jumping more than usual.  I told her she scared it into moving.  

I love Google, even though sometimes you have to wade through a lot of stuff before you get to the current stuff from reliable sources.  I'm getting better at it.  Do you find the medical websites where you have to pay for access frustrating, too?  

I remember reading that even while you're in remission, you can retain some of the symptoms of the exacerbation, without it being true progression.  I just remembered reading your post yesterday, and that popped into my head.  I suppose someone else mentioned that to you.

Have a good weekend,

Kathy