Clinical and electromyographic deep tendon reflexes in polyneuropathy: Diagnostic value and prevalence

Khema R Sharma, D. Saadia, A. G. Facca, S. Resnick, D. R. Ayyar

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background - : Evidence is accumulating that patients with polyneuropathy may present with normal clinical deep tendon reflexes (C-DTR). There are few studies that assessed the diagnostic utility of electromyographically recorded DTR (Er-DTR) in patients with polyneuropathy. Objectives - : The objectives of this study were twofold: (i) to evaluate the prevalence of preserved C-DTR in polyneuropathy; (ii) diagnostic value of Er-DTR latency measurement in patients with polyneuropathy. Methods - : We prospectively studied 38 controls and 185 patients with polyneuropathy. All subjects had evaluation of C-DTR, Er-DTR obtained from right biceps brachii (BR), right patellar (PR) and bilateral ankle reflexes (AR). Results - : Of these 185 patients, 118 (63.8%) had chronic axonal neuropathy (CAN), 49 (26.5%) demyelinating polyradiculoneuropathy (DPN) and 18 (9.7%) small fiber neuropathy (SFN). The C-DTR were normal in 65 patients whereas 39 of these 65 (60%) patients had abnormalities of Er-DTR at one or more sites. Er-DTR latencies in patients with polyneuropathies were prolonged at all sites compared with controls (P < 0.01). Among patients with various types of polyneuropathies the Er-DTR, mean latencies at all the sites and latency indicative of demyelination (>150% of the normal mean) were higher in patients with DPN than that of CAN or SFN (P < 0.01). Conclusions - : We conclude that C-DTR are preserved in 35.1% of the patients with polyneuropathies and Er-DTR should be performed in such patients in order to provide electrophysiological evidence of a polyneuropathy. Er-DTR are useful in distinguishing axonal from demyelinating disorders of peripheral nerve, and detection of subclinical involvement of large fibers in SFN.

Original languageEnglish
Pages (from-to)224-232
Number of pages9
JournalActa Neurologica Scandinavica
Volume119
Issue number4
DOIs
StatePublished - Apr 1 2009

Fingerprint

Stretch Reflex
Polyneuropathies
Polyradiculoneuropathy
Demyelinating Diseases
Peripheral Nerves
Ankle
Reflex

Keywords

  • Deep tendon reflex
  • Electromyographic reflex
  • Polyneuropathy

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Clinical and electromyographic deep tendon reflexes in polyneuropathy : Diagnostic value and prevalence. / Sharma, Khema R; Saadia, D.; Facca, A. G.; Resnick, S.; Ayyar, D. R.

In: Acta Neurologica Scandinavica, Vol. 119, No. 4, 01.04.2009, p. 224-232.

Research output: Contribution to journalArticle

Sharma, Khema R ; Saadia, D. ; Facca, A. G. ; Resnick, S. ; Ayyar, D. R. / Clinical and electromyographic deep tendon reflexes in polyneuropathy : Diagnostic value and prevalence. In: Acta Neurologica Scandinavica. 2009 ; Vol. 119, No. 4. pp. 224-232.
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abstract = "Background - : Evidence is accumulating that patients with polyneuropathy may present with normal clinical deep tendon reflexes (C-DTR). There are few studies that assessed the diagnostic utility of electromyographically recorded DTR (Er-DTR) in patients with polyneuropathy. Objectives - : The objectives of this study were twofold: (i) to evaluate the prevalence of preserved C-DTR in polyneuropathy; (ii) diagnostic value of Er-DTR latency measurement in patients with polyneuropathy. Methods - : We prospectively studied 38 controls and 185 patients with polyneuropathy. All subjects had evaluation of C-DTR, Er-DTR obtained from right biceps brachii (BR), right patellar (PR) and bilateral ankle reflexes (AR). Results - : Of these 185 patients, 118 (63.8{\%}) had chronic axonal neuropathy (CAN), 49 (26.5{\%}) demyelinating polyradiculoneuropathy (DPN) and 18 (9.7{\%}) small fiber neuropathy (SFN). The C-DTR were normal in 65 patients whereas 39 of these 65 (60{\%}) patients had abnormalities of Er-DTR at one or more sites. Er-DTR latencies in patients with polyneuropathies were prolonged at all sites compared with controls (P < 0.01). Among patients with various types of polyneuropathies the Er-DTR, mean latencies at all the sites and latency indicative of demyelination (>150{\%} of the normal mean) were higher in patients with DPN than that of CAN or SFN (P < 0.01). Conclusions - : We conclude that C-DTR are preserved in 35.1{\%} of the patients with polyneuropathies and Er-DTR should be performed in such patients in order to provide electrophysiological evidence of a polyneuropathy. Er-DTR are useful in distinguishing axonal from demyelinating disorders of peripheral nerve, and detection of subclinical involvement of large fibers in SFN.",
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