So, yesterday I had a standard medical check up (for my new job) with my new GP (I moved recently). Everything was fine except for the fact that he thought that my biceps reflexes were a bit brisk/hyperreflexive. He knows about my twitching and I had told him about my **S fears some weeks ago, but he somehow didn't relate the brisk reflexes to the twitches (he doesn't seem to know much about neurology, though).First I didn't care much about it, because I already knew that BFS often comes with somewhat brisk reflexes. But during the night, anxiety has creeped in again.On the other side, I had two clinical exams by two different neurologists plus one other medical check up with my old GP during the last two months and nobody seemed to be worried about my reflexes.What do you think about this?
Medical Check-Up Results Unexpected
- Thread starter Keiran
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The main we look for during the exam is whether or not the reflexes are symmetric. There is huge inter-individual variability - some people have very slow reflexes while some pretty active or brisk and it still can be normal for them. If there is no drastic difference between arms and legs, brisk reflexes are normal as long as they are symmetric. If one biceps seems to be normal and the other one brisk, that would be worrisome, suggesting lesion in upper motor neurons.But as you said your reflexes are brisk in biceps, I assume it is symmetrical. Bear in mind that reflex evaluation requires not only hundreds and thousands of patients to learn the normal range of responses but also the correct technique and many GPs just do not have the experience. If two neurologists were not concerned, there is no reason for you to be as well.
Hello Twitchydoc,well, he didn't exactly say that the reflexes were a bit brisk in both arms. He did them both and then said somthing like "O.k., a bit hyperreflexive." Maybe I should have asked him, if he was referring only to one or to both arms, but I didn't think about the symmetry thing at the moment.But since two neurologists weren't concerned about my reflexes I hope, everything is o.k.
Don't worry, he would have mentioned/stated in the report if had been asymmetric. And it should be noted that minor asymmetry in reflexes is normal. Again, having brisk reflexes is of no concern without other signs of hyperreflexia (like increased masseter reflex/jaw jerk, clonus, abnormal spread of reflexes etc.)You are fine.
FernFinnegan
Well-known member
Yep, I'm betting you're fine. We, with our hyperawareness take every utterance and facial expression of a doctor in an exam and over-interpret it. He should know this and keep his trap shut instead of make nervous comments when he is doing part of an exam he does not know much about, as you said neuro is not his strong suit. I have also talked with doctors (I work with many) and heard the only thing that matters is if they are symmetrical. So, without other signs, brisk reflexes are meaningless. As twitchydoc said, there is huge inter-rater and inter-individual variablity and with high anxiety and/or BFS the reflexes are expected to be a bit brisk.
Well, he didn't say anything about symmetry or asymmetry und I haven't got his report yet. But I think two neurologists and another GP would have noticed a clinically relevant asymmetry if there had been one. I myself didn't have the impression that one reflex was more brisk than the other one or that something had changed since my last visit to the neurologist.Oh, I just wish he would have kept his mouth shut. I was really fine during the last weeks and now my mind is a mess again.
FernFinnegan
Well-known member
It seems to be the nature of this beast. I too was doing sooo much better, and really still am, since clean neuro and EMG. However, I now have a new stressor unrelated to my own health, and sure enough, my thenar and upper lip have been going wild again today raising my fears again.
christinasgirl123
Well-known member
Hyperreflexia is part of BFS, and especially in the anxious phase. Even Clonus and Hoffmann's reflex are quite common in the twitching community, probably due to the stress and anxiety that go along with it. Anxiety causes a permanent increase in breathing speed and with that, a shift in blood pH and this causes hyperreflexia. While this effect is still quite moderate in BFSers, extreme chronic overbreathing can cause a total collapse similar to an epileptic episode during reflex testing. My doc has seen patients breaking out in bodywide spasms during simple knee reflex tests. This is even more impressive, as those reflexes are thought to be only happening in the body part that is tested. Increased reflexes are the bodys answer to anxiety. This is totally physiological, because our body's have to react quicker when there's a threat. Unfortunately for most of us, the bodies just forgot how to get back to a normal state.
XinaMae535
Well-known member
I am glad I found this thread because it seems I can post my questions here instead of starting a new topic.I am just learning about reflexes with BFS. I don't quite understand it and I don't want to google (I've been trying to be good), but I would like to see if anyone on here can explain this better to me (just briefly).I previously thought that brisk reflexes are a GOOD sign. A sign you are able to reflex and everything is still there and strong and if it is brisk, then you have excellent reflexes and nothing is wrong. It's hard for me to understand why they may not be a good sign. I thought that slow or slower than normal or absent reflexes are bad signs.From what I read above, and applying it to my particular situation, I gathered (I hope I'm right):If neurologist performed reflex test on me (twice within the last few months), then I should not be worried.If I perform a reflex test on myself at home, then I am wasting my time because I am probably giving myself more anxiety and am probably doing it wrong anyway (yes, I have done it) 
.As long as I don't have weakness, then twiches and reflexes should not be constantly counted, evaluated, monitored, etc. because everyone will have different reflexes and types of twitching in different areas.As long as the reflexes are symmetrical in the limbs, then don't worry. Questions:Will clinical weakness be a sign before reflexes change for the worse? Or is it the other way around?Can someone be able explain the differences in these reflexes, just briefly: brisk vs. hyperreflexia vs. clonus vs. Hoffman vs. Babinski etc. (I assume these are all different types of reflexes?). Pardon my ignorance here.And Rothharr and Leaflea - hang in there! I know how it is to be fine and then get into panic situations again (I think this is what binds us all together the most). Try and remember all of the positive stuff like you don't have weakness, or symptoms have come and gone (not gotten progessively worse), the advice here on the forum, etc.
.As long as I don't have weakness, then twiches and reflexes should not be constantly counted, evaluated, monitored, etc. because everyone will have different reflexes and types of twitching in different areas.As long as the reflexes are symmetrical in the limbs, then don't worry. Questions:Will clinical weakness be a sign before reflexes change for the worse? Or is it the other way around?Can someone be able explain the differences in these reflexes, just briefly: brisk vs. hyperreflexia vs. clonus vs. Hoffman vs. Babinski etc. (I assume these are all different types of reflexes?). Pardon my ignorance here.And Rothharr and Leaflea - hang in there! I know how it is to be fine and then get into panic situations again (I think this is what binds us all together the most). Try and remember all of the positive stuff like you don't have weakness, or symptoms have come and gone (not gotten progessively worse), the advice here on the forum, etc.Xina,very briefly:ALS ahs 2 types of damage - central and spinal. Loss of central neurons is associated with spastic activity due to hyperexcitation caused by dying neurons. That is why people with first central onset complain for strong pain, spascit muscle contraction and on the exam they have hyperreflexia. Usually it is unilateral and very prominent. we do have least pronounced form of hyperreflexia so called brisk or extended reflexes due to general cortical hyperexcitation of our brain (also maifested as anxiety). usually it is bilateral and harmless and goes away with the quenching of anxiety.Hoffman and Babinsky signs are 'ancient' relexes, which usually are not found in adults but toddlers and people with the brain traumas may have Babinsky reflex. people with hyperexcited brain cortex also may develop it more or less sometimes.so you can see that one needs to ne really well educated and trained to distinhuish if the person in really ill or just hyperexcited due to anxiety.
XinaMae535
Well-known member
Gracely, thanks a bunch for the overview. I feel like I have a better understanding now. 
You mentioned:"Loss of central neurons is associated with spastic activity due to hyperexcitation caused by dying neurons."So by this I feel my other question was answered, that if neurons are dying, then the clinical weakness should be present first. But I may have gotten that wrong, or that may not always be the case.And spastic activity and spastic muscle contraction - I understand this to be when muscles cramp very apparently and painfully where you can't move them so the person definitely notices this happening. I have not concerned myself too much with this area (or the reflexes) since I do not have cramps, just the feeling like my muscles will cramp or want to cramp, but not any real cramps and definitely not extreme ones.
You mentioned:"Loss of central neurons is associated with spastic activity due to hyperexcitation caused by dying neurons."So by this I feel my other question was answered, that if neurons are dying, then the clinical weakness should be present first. But I may have gotten that wrong, or that may not always be the case.And spastic activity and spastic muscle contraction - I understand this to be when muscles cramp very apparently and painfully where you can't move them so the person definitely notices this happening. I have not concerned myself too much with this area (or the reflexes) since I do not have cramps, just the feeling like my muscles will cramp or want to cramp, but not any real cramps and definitely not extreme ones.