No Patellar Reflex (knee-jerk)

[mama2alex]

We saw an LLMD last week and are starting on Rifampin on Tuesday (after the long weekend) b/c of a positive Bartonella lab. We're doing more testing while waiting to see ds10's response to the new antibiotic, including CBC and tests for viruses, molds, and rechecking vitamin D.

 

The LLMD did a pretty thorough physcial exam, which I appreciated. The one thing that popped out to me was that when he tapped my son's knee's with the little hammer, nothing happened. We both looked at each other, then he tried again - nothing. I didn't ask what this could mean, because I was worried what the answer would be and didn't want my son to hear something scary. The doctor didn't say anything, but then checked his feet by drawing a tongue depressor or something down the bottoms of his feet, and thankfully, he definitely felt it.

 

I looked this up on Wikipedia and it says lack of patellar reflex is called Westphal's Sign. It can indicate the following:

 

"Westphal's sign has a clinical significance used in determining neurodisorders or diseases such as:

-receptor damage, peripheral nerve disease, involving the dorsal(sensory)columns of the spinal cord and cerebellar lesions

-lesions present within the motor cortex of the brain or the pyramidal tracts which it combined with muscular spasms

-complete interruption of sensory and/or motor impulse transmission in the femoral nerve"

 

I'm wondering if anyone else has seen this in their child (or themselves) and what it means.

[kimballot]

I have been thinking about your post all day... wondering what the reason could be. The doc had no explanation - huh?

 

Sometimes people can cognitively override the Patellar Tendon reflex and not "make it happen" even though the doc tells them to relax. That is one possibility.

 

I am also wondering if your son has had any problems with coordination, balance, or other motor skills lately.

 

I don't know much about the whole lyme connection, but I do know that the book "cure unknown" talks about a man who thought he had ALS (Lou Gehrig's disease- which does NOT happen to children), and was actually preparing to die. As it turned out, his lyme symptoms were mimicking ALS and once he had the right antibiotic treatment, the symptoms went away!

 

I am wondering if bartonella could cause similar problems and perhaps the DTRs will return following ABX treatment?

[mama2alex]

Well, I will ask the doctor what he thinks it means at some point, but I just didn't want to do it in front of my son. As for coordination, he didn't walk until 14 1/2 months and then fell enough times that he had 15 stitches on his face by the time he'd been walking for 5 months. He's never been especially coordinated, has always struggeled with handwriting, and I did notice that when he has a PANDAS exacerbation, he starts dropping things, spilling things and running into doorways right and left.

 

I have been thinking about your post all day... wondering what the reason could be. The doc had no explanation - huh?

 

Sometimes people can cognitively override the Patellar Tendon reflex and not "make it happen" even though the doc tells them to relax. That is one possibility.

 

I am also wondering if your son has had any problems with coordination, balance, or other motor skills lately.

 

I don't know much about the whole lyme connection, but I do know that the book "cure unknown" talks about a man who thought he had ALS (Lou Gehrig's disease- which does NOT happen to children), and was actually preparing to die. As it turned out, his lyme symptoms were mimicking ALS and once he had the right antibiotic treatment, the symptoms went away!

 

I am wondering if bartonella could cause similar problems and perhaps the DTRs will return following ABX treatment?

[Toms_Mom]

My son had the same thing happen at his neurologist visit 3 yrs. ago. It scared me too. I asked him what was wrong and he said "he's fine- I can see a reaction" or something like that. I still wonder though what that means. I'm not sure if my son is pandas or not. He has a tic only disorder, although it came on suddenly with ocd at the time. He no longer has ocd, but a few months ago I took him in for a strep test during a heavy tic period and he tested positive. My ped gave him a 5 day course of antibiotics which seemed to help, but not sure what to do now. We live in SC and I haven't heard of any Pandas drs. in this area.

[kimballot]

Tom's Mom - Sometimes there is a trace contraction of the muscle that you can't see, but the doctor can feel. Maybe that is what happened?

[Phasmid]

In the absence of a patellar reflex, the doc would have ordered further tests since this is a neurological sign. Since he didn't mention anything, I wouldn't be concerned. A negative patellar reflex would have been cause for great concern.

[mama2alex]

Thanks for all the responses! I think I'll call the office on Tuesday just to confirm that he saw some response that I didn't see. I'll just feel more comfortable following up.

 

Phasmd, why is a neg patellar reflex cause for great concern?

[sptcmom]

Hi

Its all basic neuro exam.

You need to know if reflex was negative (zero) or dampened (1+) as graded by the doc. Secondly the bottom of foot reflex is called Babinski sign or looking for it. What was your child's reaction- did the toe/foot go upwards/extend as in toe goes towards nose or did it flex downwards. Both legs or one leg. How about the arm reflexes. Did your doc use reinforcers as in asking your child to clench fist or lock fingers together and pull apart- did that maneuver change the status of the reflexes? Based on ALL this the doc will determine if its a local Lower motor neuron/spinal level issue or a cortical/uppermotor neuron or brain issue.

PANDAS issues as in Basal Ganglia inflammation will NOT cause any reflex issues as far as I know.

Lyme can cause local spinal, local muscular reflex arch level or even cortical involvement.

Pandas can cause neuropathy but that would also manifest as low muscle tone and weakness.

My DS had damp reflexes (1+) and we did an MRI of brain and spine but all was normal.

Turns out he has Bartonella.

Regards

Jodie

[mama2alex]

Thanks Jodie! I'll call tomorrow, and your information will help me ask intelligent questions and understand the answers. I don't know the details of his responses to the other tests, because I didn't know what to look for. I just knew that when neither leg moved when he was tapped on the knees, that wasn't right.

 

My son also tested positive for Bartonella and we're starting Rifampin tomorrow.