Differentiating extensor plantar response in pathological and normal population
Document Type
Article
Publication Date
1-1-2018
Abstract
Introduction: Approximately 5%-11% of neurologically normal population has extensor plantar response (EPR). Method: This study is aimed to identify differentiating features of EPR between physiological and pathological population. Results: A total of 43 patients with pyramidal lesions and 113 normal controls were recruited for this study. The pathological EPRs were more reproducible, with 89.4% having at least two positive Babinski responses and 91.5% having two positive Chaddock responses (vs. 14.3% and 4.8% in controls, P < 0.001). The pathological EPR was more sensitive to stimulation, in which 89.1% were elicited when the stimulation reached mid-lateral sole (vs. 11.9% in controls, P < 0.001). Most (93.6%) pathological cases had sustained big toe extension throughout stimulation (vs. 73.8% in controls, P < 0.001). As compared to those with brain lesion, the plantar responses in those with spinal lesion are less likely to have ankle dorsiflexion (5.3% vs. 25%, P < 0.05) more likely to have sustained extensor response with Babinski (94.7% vs. 71.4%, P < 0.05), Chaddock (89.5% vs. 64.3%, P < 0.05), and Schaefer (26.3% vs. 3.6%, P < 0.05) methods. A scoring system was computed using four variables, i.e., two consecutive positive Babinski or Chaddock responses, extensor response at mid-lateral sole, and sustained extension throughout stimulation. A score ≥3 is predictive of pathological origin, with sensitivity and specificity of 78.7% and 95.2%, respectively. Conclusion: The pathological EPR is more reproducible, sensitive to stimulation, and sustainable compared to physiological extensor response.
Keywords
Babinski, Chaddock, physiological plantar response, plantar responsere, flex, Schaefer
Publication Title
Annals of Indian Academy of Neurology
Divisions
fac_med
Volume
21
Issue
2
Publisher
Medknow Publications