Question - reflexes

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Posted by CCF MD mdf on March 16, 1998 at 12:50:32:

In Reply to: Question - reflexes posted by Anonymous on March 14, 1998 at 09:32:36:

: I have had history resembling MS episodes, but negative MRI and spinal fluid, have been told I must have psychological problem for three years.  My condition has declined considerably over the past year, have tremor, weakness, bad balance, cognitive and speech problems residual.  I posted previously with question about extreme reaction to heat, and received your answer, for which I thank you.
  Trying to find a solution to the severe problems with weakness and lack of coordination with my hands and arms, I saw a physiatrist, thinking that maybe carpal tunnel or something treatable was responsible for this part of it.  She referred me to another neurologist.  Upon exam, he said that almost all of the exam was abnormal, with brisk reflexes, Babinski sign, and more involving coordination and balance.  This is not in connection with an episode, but between, my now usual condition.   He wanted to refer me to MS specialists, and I declined, because he said he would treat me and I could go there with bad episodes, and at last someone believes it's not all in my imagination.
  This doctor now takes it seriously, and says I have MS clinically by exam and history, but cannot be diagnosed definitely for preventive medication without laboratory positives.  What I want to know, in the event he insists upon my going to MS specialists later:  Is it possible for a psychological problem to cause reflex abnormalities of these types, also nystagmus which has been recorded twice before?  Can I now be excused from the "psych" diagnosis category now that the neurological exam is abnormal enough?  Which of these exam findings can (or can all) be attributed to psychological origin?
  I appreciate your answering my questions.
  
=
Some signs on neurologic exam are more "hard" than others in terms of interpreting their origin in anatomic/physiologic vs psychologic/functional factors. MS is a complicated disease, and it may occur without definitive lab abnormalities, making the diagnosis and treatment quite frustrating (especially for the patient).
Brisk reflexes per se might not be abnormal, but Babinski's sign is never seen in the absence of pathology. Coordination and balance problems are more subtle, and interpretation relies more on the experience of the examiner than anything that can be looked up in a book. With neurologic disease in general, interpretation of a specific physical exam finding is done in the context of other history details or exam findings.
It really isn't a bad idea for you to consult an MS specialist. The experience he/she brings to the examination should help with the diagnosis, and if there are any treatments available to slow down progression or reduce symptoms, I think you'd want to know. There is a very capable group of MS experts here at the Mellen Center at the Cleveland Clinic, or if you live at a great distance you may try an academic/university center near you. You may call 800 223 2273 and ask for neurology appointments (Mellen Center).
Hope this helps. CCF MD mdf.