BABINSKI SIGN AND ALS

HI!

Dear Doctor!



.what is the significance of absent babinski - no response at all?
I know that toes going up -bad sign while toes going down  - good sign but what about no response at all ? Is it as normal as toes going down ( I have been told that toes  doing nothing is also normal - Is it correct?
according to your clinical experience - How is the babinski sign in als patients? ( I read that 40 % have positive babinski)
what about the other - Do they have toes going down or no response at all -  Is no response ominious in relation to ALS?Thanks in advance!

[CCF Neuro[P] MD, RPS]

Dear Bob:

An absent babinski sign usually is considered within the realm of normal variation.  ALS is the combination of upper and lower motor neuron signs, which can be accompanied by a positive babinski sign (up-going toes) and suggestive of an upper motor neuron lesion.  But, the up-going toes do not have to be present in ALS.  There can be the bulbar onset ALS which does not have a babinski sign.  I would not focus on the absence of a babinski sign as significant.

I hope I answered your question.

CCF Neuro MD

[mgh]

DAN!

[We warned you all]

Dan is clogging the arteries of posting time again.Dan, take the form fitting jacket with the nice straps in the back off and join us in the real world.Fasiculations do not equal ALS. Tell me true CCF neuro,are you guys happy with the idea that everyone who twitches thinks they are dying, as it drums up EMG business, or you ready to bang your heads against the wall, telling the Dan's of the world that they'll live.

[barbara to pain and lortab]

You think twitching is bad, try alcohol withdrawal partial reactive tonic-clonic convulsive seizures. Those are real fun.

They come in a serires of two or three and last anywhere from 8-10 minutes each. Being partial, I do not pass out so I feel the entire (shakedown) as I like to call it.

If you want to take a little test of your ability to withstand pain and twitching, try this little isometric excercise.

Extend both arms straight out and tighten your muscles as hard as you can until your arms are shaking violently as if in a seizure. Then try to see how long you can hold it. I bet not much longer than a couple of minutes due to severe muscle cramping and pain.

Then imagine your entire body convulsing like that and lasting 10 minutes, two to three times in a row without stopping and you have no control to stop it. It's like being under torture. So stop whining about a little twitching unless it is truly interfering with your life.

[Adele]

what is bulbar onset ALS and what kind of time frame are we talking about?  What are the symptoms?