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. 2014 Apr;17(2):199-201.
doi: 10.4103/0972-2327.132628.

Intact thumb reflex in areflexic Guillain Barré syndrome: A novel phenomenon

Karkal Ravishankar Naik  1 , Aralikatte Onkarappa Saroja  1 , Manik Mahajan  2
Affiliations

Intact thumb reflex in areflexic Guillain Barré syndrome: A novel phenomenon

Karkal Ravishankar Naik et al. Ann Indian Acad Neurol. 2014 Apr.

Abstract

Introduction: Areflexia is one of the cardinal clinical features for the diagnosis of Guillain Barré syndrome. However, some patients may have sluggish proximal muscle stretch reflexes. Presence of thumb reflex, a distal stretch muscle reflex has not been documented in Guillain Barré syndrome.

Materials and methods: We prospectively evaluated thumb reflex in Guillain Barré syndrome patients and age matched controls from April to September 2013.

Results: There were 31 patients with Guillain Barré syndrome in whom thumb reflex could be elicited in all (24 brisk, 7 sluggish), whereas all the other muscle stretch reflexes were absent in 29 patients at presentation and the remaining two had sluggish biceps and quadriceps reflexes (P = 0.001). Serial examination revealed gradual diminution of the thumb reflex (P < 0.001). Rapid progression of weakness was associated with early loss of the thumb reflex.

Conclusion: Thumb reflex, a distal stretch reflex is preserved in the early phase of Guillain Barré syndrome.

Keywords: Acute flaccid paralysis; Guillain Barré syndrome; muscle stretch reflex; thumb reflex.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Photograph showing the method for elicitation of the thumb reflex. The examiner's thumb placed over flexor pollicis longus on the volar aspect of the forearm (junciton between distal 1/3 and proximal 2/3) is struck firmly with reflex hammer
Figure 2
Figure 2
The surface showing recorded electromyographic (EMG) signals from flexor pollicis longus. EMG signals triggered the sweep with delay of -5 divisions. Waves in the top are the superimposed eight trials and the bottom trace is the averaged response
See this image and copyright information in PMC

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