How are your reflexes and strength during neuro exam?

[Catlover80]

Hi,

I'm just wondering if a person with MS could have normal reflexes and muscle strength during a neuro exam? I can't find much info and it doesn't seem to be discussed much on here.

I'm guessing results could be normal if a person has RRMS and no active lesions during time of office exam. I think i've read results are dependent on location of lesions.

Curious to know what others experiences are like. Thanks!

[lstrl]

It is going to depend on where your lesions are and how MS affects you. Everyone is going to be different. Even though I do have leg weakness, I still show 5/5 on strength when the neuro examines me. Mine also comes on with fatigue and it happens quickly, but when I'm just sitting there, the neuro can't pick up on that weakness. I've also always had normal reflexes until this last visit. Right now they're stronger than normal and when the neuro tested my knee reflex, my leg flew up and almost kicked him, and as much as I've wanted to do something like that, it really was my body, not my mind

[fishead]

My reflexes are HYPER, but my strength is good.
just FYI re: your question

[MSW1963]

*WARNING SNARKY-ISH REPLY*

Reflexes in my arms are hypo or absent, and reflexes in my legs usually are on the hyper end of the scale.

IMO, my muscle strength is astonishingly good on exam, for the full 3-5 seconds of pushing/pulling. My good muscle strength is a bit deceptive because I experience muscle fatigue under normal demands of life, such as necessary walking at the super market or the walk across the medical campus to my neuro's office for my appointments.

Interesting that early in my dx, PT therapist observed a few abnormal issues that my MS neuro's, then and now, are not aware of, at least as far as I know. I think PT evaluations are more intensive and thorough than the neuro exam. If only my MS neuros read the PTs report.

I'm not sure if it's the 'pep talk' neuro's are serving up for MSer intended to make us or them feel better, but it's not the least bit effective in my case.

I don't think it's unusual for 'gross' motor functions evaluated during the typical neuro exam to go over looked or minimized, or to be considered minor for MS neuros who treat a variety of MS patients ranging from highly functional to the most disabled.

[SNOOPY]

I don't think it's unusual for 'gross' motor functions evaluated during the typical neuro exam to go over looked or minimized, or to be considered minor for MS neuros who treat a variety of MS patients ranging from highly functional to the most disabled.

Very true.

My neuro exam is not normal but not necessarily as bad as someone with a more progressive or aggressive course. So, for someone who has had MS diagnosed for almost 30 years my strength vs. weakness isn't too bad.

Catlover80
I'm guessing results could be normal if a person has RRMS and no active lesions during time of office exam

I have never had a normal neuro exam. Have always shown a Babinski response, weakness and Hypo rather than Hyper reflexes.

[502E79]

Hi,

I'm just wondering if a person with MS could have normal reflexes and muscle strength during a neuro exam? I can't find much info and it doesn't seem to be discussed much on here.

I'm guessing results could be normal if a person has RRMS and no active lesions during time of office exam. I think i've read results are dependent on location of lesions.

Curious to know what others experiences are like. Thanks!

Hi Catlover80,

As answer to your question— sure, but I would be guessing as to any reason... we are talking MS here... so who really knows?

My neuro never really comments on responses to his dog & pony show requests. I can usually judge how I did simply knowing my own body.

One thing I have noticed (not to muddy the waters), there is something called "white coat syndrome" which attributes poor test responses to patient anxiety due to the doctors presence.

We MS'ers are well versed in anxiety.... I know I've allowed that white coated rascal to rattle me @ times.

Jer

[AnneLouise]

I have good strength but my reflexes are crazy. Have been in the six years since dx. And the doc checks nearly every visit.
I have several lesions on my c-spine, my knees are the worst.

I'm getting to dread that little hammer.

[22cyclist]

I have hyper reflexes. My lesion in my brainstem makes my whole left side weak so its about a 3/5. I have never had a normal exam either, positive Babinski both sides, intention tremor, chronic BINO (eyes).

Lisa

[rdmc]

Depending on the location of lesions, and the kind of neuro exam you're having, I think it would be possible to have normal strength during an exam, but I do think reflex problem would show up, unless your MS does not include reflex issues as a symptom or you have RRMS and are in a complete remission of symptoms.

Plus, as far as I've experienced, there are two types of neuro exams. The 5 minute kind, and the 30 minute kind. The full neuro exam (which usually only happens at your first trip to a new neuro) is much more likely to catch weakness and strength issue because they ask you do do things "longer" to get the response one normally gets from MS , i.e. tap your finger on a table...I'm great at that for about 15 seconds, then the ataxia and weakness sets in, and it's obvious there's a problem.

The 5 minute kind you get at subsequent visits, will detect reflex problems, drop foot, babinski, eye tracking issues, balance problems, etc. but not the more subtle symptoms one might have.

That being said, my neuro exam has always been "off." Even when they didn't know it was MS, they knew it was something because of drop foot, cranial nerve problems like sticking out my tongue, etc.

I used to have hyper reflexes, now I have none. I'm guessing this is mostly due to the effect of the Baclofen pump.

Weakness is more tricky...as someone mentioned a PT eval is much more likely to show weakness than a short neuro exam. Sometimes you might have a limb that is obviously weak (I have one hand that has no grip)...but the other weakness I know I have don't shout out weakness during the 5 minute type of exam.

[marti]

I always test positive for Romberg and they always have a hard time finding any reflex in my left arm. I don't know about the other stuff because THE DOCTOR NEVER EXPLAINS ANYTHING! Why can't they tell you what they are finding and what they are not seeing as normal?

[Jennagain]

Anything is possible

You are wondering if a person can have MS and have normal reflexes? I am not a medical professional, but would say that likely yes you can. On the flipside many people have abnormal reflexes and no diagnosis so I guess anything goes.

My neuro reflexes are very abnormal, yet I have no diagnosis. Have Babinski sign on both sides, hyper reflexes in both knees and no reflexes at all on left foot. Weakness shows in all limbs.

My exams have been very dynamic over the years, but always abnormal to varying degrees. My neuro had said this was very indicative of MS. That being said, people must present differently all the time depending on whether or not they are having a flare. It seems anything goes!

[pennstater]

My reflexes and strength do test normal. They are weaker than before, but still normal. It is one of the reasons I had trouble obtaining disability. I have Babinski bilaterally, left eye doesn't always track, and now have balance issues.

It doesn't have to tie to active lesions. It could be older lesions and progression. Additionally, it is harder to tie brain lesions to specific symptoms, as opposed to spinal lesions.

[Marco]

Sometimes hypo, mostly hyper, but rarely normal.

I suffer from severe spasticity and my strength was normally 2+/3-. I did not have control of my muscles, until after getting a baclofen pump; now my strength is mostly up to 4+/5-. I have been doing PT since 2012, and we are finally making gains. Never give up, never give in!

[Waydwnsouth1]

I don't have normal Neuro exams. My reflexes are always hyper and the lack of strength in my legs is obvious. My balance or lack thereof is obvious. I don't always have a Neuro exam. When I do it's usually short and quick.

The only long exam I have had is the one when I was dx. The icing on the cake was the heel to toe walk. I couldn't take one step without falling. He then had me lay back down on the exam table and drug the wooden tip of a swab down my stomach three times on both sides. That's how I was dx. He said I no, some type of muscle, control. Your navel is supposed to move to the side the swab is being drug. Mine didn't react at all. Sounds odd I know. But the follow up MRI confirmed the dx. As has everything that has happened since.

Kind of the history of my Neuro exams.

[pennstater]

Jinxed myself by earlier response. No longer normal reflex on right side...found out at Monday appointment. But I was normal for 9 years