Reflexes and Evoked Potentials: What do they tell you about your spinal cord? - Page 2

kaye · 11-23-2003, 04:43 PM

Dr. Wise,
My grandson Isaac (5 years old) is T5/6 complete. It's hard to tell what his sensation level is due to his age, he is inconsistant. He will tell me that his foot moved and that he feels it in his knee and lower stomach/groin area. When you clean his genital area his legs will raise (knees bend/thighs rise). He is 9 months post injury. These movements just started within the last 4-6 weeks. What does it mean?

Wise Young · 11-23-2003, 08:51 PM

Kaye, hip flexion in response to stimulation of the groin is a natural reflex, one that I neglected to mention. On the other hand, the fact that it is returning 8 months after his injury does suggest that there are excitability changes in his lower spinal cord.

Neurological examination of young children is hard for a variety of reasons. First, their spinal cords are not yet fully developed. I remember being shocked when I did somatosensory evoked potentials for the first time in young children in the operating room and finding that the sensory signals took much longer to reach the brain in children under age 8 than it takes in adults. This is surprising since the conduction distance in children is so much shorter (about a third or even less) than the adult. Conduction times do not reach adult levels until just before puberty, suggesting to me that human children may not be myelinating completely until quite late. When my children were smaller, I used to check their reflex times. You should try it. Until age 9-10, most kids cannot catch a ball as fast when it is tossed to them.

Wise.

kaye · 11-24-2003, 07:10 AM

Dr Young,
Does the fact that Isaac feels some of his involuntary leg and foot movements in his knees thighs and groin, indicate nerve activity reaching his brain via the spinal cord?

Wise Young · 11-24-2003, 10:23 AM

Quote:

Originally posted by Kaye:

Dr Young,
Does the fact that Isaac feels some of his involuntary leg and foot movements in his knees thighs and groin, indicate nerve activity reaching his brain via the spinal cord?

These are spinal reflexes that are programmed in and reside in the spinal cord. Some reflexes require interaction with the brainstem, i.e. alteration of stepping in response to stimulation of the top of the foot, but I believe that the flexion response to groin stimulation is something that is present in the spinal cord.

I understand that you are looking for hopeful signs. The important and most hopeful sign to me is the re-establishment of reflexes indicating that his lower spinal cord is intact and functioning. The fact that he may be able to tell when his limbs are being moved is also good. Finally, at 9 months after injury, I believe that he will continue to recover.

Unfortunately, relatively little is known about recovery of children from spinal cord injury. Although there is a sense in the field that recovery is better in children than in adults, I am not sure that this is the case from personal experience. What is good is that Isaac is older and has passed many of his motor milestones (such as walking). Whenever children are injured and therefore cannot do the things that are essential for their motor development, some of the motor systems do not complete development. I think that Isaac is beyond those milestones.

Wise.

tucker · 11-24-2003, 11:52 AM

Dr. Young,

I have read with fascination your guidence to self asessment for clues to neurological condition. My injury is c7 t1 incomplete. I have all the reflexes you described. Further, from your explanation, I should have pretty much intact motoneurons below my level of injury. I have normal proprioception, almost normal sensation (with the exception of temperature distinction and I have pretty severe neurologic pain). I am able to have sex and I urinate without catheterization. My MRI shows just a slight discolered mark on it and I have spinal stenosis which was just diagnosed (I have no idea how long I have had it. There is also bony encroachments causing forminal narrowing at about c5 c6.

So even though, I appear to have encouraging signs in terms of intact motoneurons below my level of injury, I haven't walked in 18 years inspite of intensive training including treadmill training (which by the way - did work in terms of enabling me to walk short distances with balance support) and experimental drugs.

The only reason I am telling my story is to raise the question, practically speaking, how valuable is it to have intact motoneurons and a spinal cord that is intact if inspite of a long, determined and desperate effort to walk for years and years one hits a wall.

By the way, I really enjoyed hearing someone (you) with the unusual insight of looking at spacticity as potentially useful and encouraging. Most doctors unthinkingly presume it is bad and try to eliminate it with powerful meds. It has helped me walk with balance support and stand. It has also prevented me from atrophy, even 18 years post accident.

flashfox · 11-24-2003, 12:42 PM

Quote:

Originally posted by Wise Young:

Paolo Peri,

)?

By the way, if your answers to the questions 1-4 are mostly yes, it means that most of your spinal neural circuitry to leg muscles are still intact, even. If you can feel the somatosensory evoked potential stimulation, this suggests that you have some sensory signals that are getting through the injury site. Likewise, if stimulation of your brain is causing any detectable twitching for muscles below T6, it suggests that you have some motor axons.

So what do you think?

Wise.

Wise thank you !

all my answer 1 to 4 are yes also i have very strong spasm in my lower stomach muscles when i go to bed with a very strong extension of the legs.Point 5 i cannot feeling anythink when are stimulation of nerves below the injury site during the tests the same for stimulation of my brain isn't causing any detectable twitching for muscles below T6 .

Do you think that i am good candidate for EOG transplant . In summary my lower spinal neural circuitry to leg muscles are intact i don't understand why my left anterior tibial muscle is so atrofized(80%) the MRI don't show some damage below t6 .

Wise Young · 11-24-2003, 04:15 PM

Quote:

Originally posted by tucker:

Dr. Young,

I have read with fascination your guidence to self asessment for clues to neurological condition. My injury is c7 t1 incomplete. I have all the reflexes you described. Further, from your explanation, I should have pretty much intact motoneurons below my level of injury. I have normal proprioception, almost normal sensation (with the exception of temperature distinction and I have pretty severe neurologic pain). I am able to have sex and I urinate without catheterization. My MRI shows just a slight discolered mark on it and I have spinal stenosis which was just diagnosed (I have no idea how long I have had it. There is also bony encroachments causing forminal narrowing at about c5 c6.

So even though, I appear to have encouraging signs in terms of intact motoneurons below my level of injury, I haven't walked in 18 years inspite of intensive training including treadmill training (which by the way - did work in terms of enabling me to walk short distances with balance support) and experimental drugs.

The only reason I am telling my story is to raise the question, practically speaking, how valuable is it to have intact motoneurons and a spinal cord that is intact if inspite of a long, determined and desperate effort to walk for years and years one hits a wall.

By the way, I really enjoyed hearing someone (you) with the unusual insight of looking at spacticity as potentially useful and encouraging. Most doctors unthinkingly presume it is bad and try to eliminate it with powerful meds. It has helped me walk with balance support and stand. It has also prevented me from atrophy, even 18 years post accident.

tucker,

I have long disagreed with the practice of just letting it go. It is common sense that every effort be made to maintain the spinal cord below the injury site.

1. Regenerative therapies will not work as well if the regenerating axons have less to connect with.
2. Spinal reflexes are important and perform a lot of functions for your body, even though you may not have voluntary control of those functions.
3. Muscles and organs undergo atrophy without the neural circuitry. Also, of course, the reflexes are what maintains the organs.

Wise.

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11-23-2003, 04:43 PM	#11
kaye Member Join Date: Sep 2003 Location: Seguin, TX, USA Posts: 53	Dr. Wise, My grandson Isaac (5 years old) is T5/6 complete. It's hard to tell what his sensation level is due to his age, he is inconsistant. He will tell me that his foot moved and that he feels it in his knee and lower stomach/groin area. When you clean his genital area his legs will raise (knees bend/thighs rise). He is 9 months post injury. These movements just started within the last 4-6 weeks. What does it mean?

11-23-2003, 08:51 PM	#12
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	Kaye, hip flexion in response to stimulation of the groin is a natural reflex, one that I neglected to mention. On the other hand, the fact that it is returning 8 months after his injury does suggest that there are excitability changes in his lower spinal cord. Neurological examination of young children is hard for a variety of reasons. First, their spinal cords are not yet fully developed. I remember being shocked when I did somatosensory evoked potentials for the first time in young children in the operating room and finding that the sensory signals took much longer to reach the brain in children under age 8 than it takes in adults. This is surprising since the conduction distance in children is so much shorter (about a third or even less) than the adult. Conduction times do not reach adult levels until just before puberty, suggesting to me that human children may not be myelinating completely until quite late. When my children were smaller, I used to check their reflex times. You should try it. Until age 9-10, most kids cannot catch a ball as fast when it is tossed to them. Wise.

11-24-2003, 07:10 AM	#13
kaye Member Join Date: Sep 2003 Location: Seguin, TX, USA Posts: 53	Dr Young, Does the fact that Isaac feels some of his involuntary leg and foot movements in his knees thighs and groin, indicate nerve activity reaching his brain via the spinal cord?

11-24-2003, 11:52 AM	#15
tucker Senior Member Join Date: Jul 2003 Posts: 119	Dr. Young, I have read with fascination your guidence to self asessment for clues to neurological condition. My injury is c7 t1 incomplete. I have all the reflexes you described. Further, from your explanation, I should have pretty much intact motoneurons below my level of injury. I have normal proprioception, almost normal sensation (with the exception of temperature distinction and I have pretty severe neurologic pain). I am able to have sex and I urinate without catheterization. My MRI shows just a slight discolered mark on it and I have spinal stenosis which was just diagnosed (I have no idea how long I have had it. There is also bony encroachments causing forminal narrowing at about c5 c6. So even though, I appear to have encouraging signs in terms of intact motoneurons below my level of injury, I haven't walked in 18 years inspite of intensive training including treadmill training (which by the way - did work in terms of enabling me to walk short distances with balance support) and experimental drugs. The only reason I am telling my story is to raise the question, practically speaking, how valuable is it to have intact motoneurons and a spinal cord that is intact if inspite of a long, determined and desperate effort to walk for years and years one hits a wall. By the way, I really enjoyed hearing someone (you) with the unusual insight of looking at spacticity as potentially useful and encouraging. Most doctors unthinkingly presume it is bad and try to eliminate it with powerful meds. It has helped me walk with balance support and stand. It has also prevented me from atrophy, even 18 years post accident.