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lack of reflex response

Posted by M on April 27, 1999 at 10:33:55
I have a seizure disorder, named migraine epilepsy syndrome(?), atonic bladder (4 years self cath), thoracic outlet syndrome and "probable" fribromyalgia.
At a recent physical, it was noted that several reflex responses were not present, mainly left side, knee and arm, where neurologic problems present when seizure is happening and basilar migraine symptoms present.
1)What significance does absent reflex have?
2) With the probable fribromyalgia, it was stated in a report that "18 of 18 tender points exhibited exquisite pain, although control points were negative"  What are control points? I have an idea but would like your opinion.
I thank you very kindly for your response,

Posted by CCF MD GS on April 27, 1999 at 15:24:33
Thanks for the question. The lack of reflexes in the arm and leg are interesting. It sounds as if they are present when you are not having neurologic symptoms and absent when you do. Patients can have complicated migraine which refers to neurologic symptoms during the migraine such as weakness. The loss of reflexes may reflect the affect that the migraine is having on the brain. It doesn't necessarily mean anything bad in itself. The 18 of 18 tender points and 0 controls refers to locations of sites known or not known to be involved with FMS. The 0 controls would be a control to make sure that not "everything" hurts and the person truely has the defining characteristics of the disorder. Hope that helps.
This information is provided for general medical education purposes only. Please consult your doctor regarding dignostic and treatment options.

Posted by M on April 27, 1999 at 20:46:57
Thank you for the response.  When I saw my PCP yesterday the only symptoms I was having was severe, sciatica type, back of my hip, pain.  What is interesting is that it was on the right side and the lack of reflex was on the left.
My migraines have evolved from the type you descirbe with neurologic"symptoms"  into what are descibed by one Neuro Doc as partial complex seizures.  I do not lose consciousness but lose some cognitive ability and have involuntary movement of LEFT arm, sometimes leg, facial distortions with chewing motions and almost non-stop movement of my head and neck.  
This is almost "thrashing" sometimes but is usually over within fifteen minutes to half an hour. I have an aura so I know when it is coming. we have started phenobarb which is helping reduce after 6 weeks but not eliminate them.
My point, and I do have one, (ha ha) is that I wondered about the significance of the lack of reflex to tie in with the neurogenic bladder, seizures, migraine
fribromyalgia and el nino. (kidding)
Thanks so much for your help,

Posted by CCF MD mdf on April 27, 1999 at 23:42:01
At issue is whether you have loss of reflexes on the right, or increased reflexes on the left.
Diminished reflexes typically reflects damage or dysfunction of peripheral nerves or nerve roots. Increased reflexes may reflect dysfunction of or damage to central nervous system structures (spinal cord and/or brain).
If you are not sure, you may want to see a neurologist for an exam. Exams change dynamically, so the reflex difference may go away and not turn out to mean anything. But if you have a persistent change, you'll want someone with neurologic diagnostic experience to examine you to localize and diagnose the problem.
I hope this helps. CCF MD mdf.

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