From the Guidelines
Achilles and knee jerk reflexes graded as 2+ bilaterally indicate normal neurological function, suggesting no immediate need for intervention, as evidenced by the standard reflex grading scale 1. In the context of neurological assessment, deep tendon reflexes like the Achilles and knee jerk reflexes are crucial for evaluating the integrity of the nervous system. The grading of these reflexes, from 0 to 4+, provides valuable information about the neurological status of a patient. A grading of 2+ is considered normal, indicating that the reflex arc, which includes sensory neurons, synapses in the spinal cord, and motor neurons, is functioning properly.
- The standard reflex grading scale is as follows:
- 0: Absent reflex
- 1+: Diminished reflex
- 2+: Normal reflex
- 3+: Increased reflex, not necessarily abnormal
- 4+: Hyperactive reflex with clonus
- A finding of 2+ bilaterally for both Achilles and knee jerk reflexes suggests intact sensory and motor pathways in the lower limbs, corresponding to spinal segments L2-L4 for knee jerks and S1-S2 for Achilles reflexes. Given the information from recent studies on neurological conditions, such as Guillain-Barré Syndrome, which often presents with decreased or absent reflexes 1, a normal reflex finding is reassuring. However, consistent documentation of reflex grading over time is essential for early detection of any changes that might indicate developing neurological issues.
- Monitoring reflexes is particularly important in conditions where neurological decline can occur rapidly, as seen in Guillain-Barré Syndrome, where reflexes are typically decreased or absent at some point in the clinical course 1. Therefore, in the absence of other neurological deficits or symptoms, a patient with 2+ bilateral Achilles and knee jerk reflexes can be considered to have normal neurological function in the context of these reflexes, based on the most recent and highest quality evidence available 1.
From the Research
Akelies and Knee Jerk Reflexes
- The relationship between akelies, knee jerk reflexes, and vitamin B12 deficiency is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that vitamin B12 deficiency can cause neurological symptoms, including peripheral neuropathy, myelopathy, and myeloneuropathy 2, 3, 4, 5, 6.
- These neurological symptoms can affect the nervous system's ability to conduct signals, potentially impacting reflexes such as knee jerk reflexes 4, 5, 6.
Bi-Lateral Involvement
- The studies do not specifically address bi-lateral involvement in the context of akelies and knee jerk reflexes.
- However, they do report on the presence of bilateral symptoms and signs in patients with vitamin B12 deficiency neurological syndrome, including impaired joint position and vibration sensation in the lower limbs 3.
- Bilateral involvement is also suggested by the presence of abnormal nerve conduction studies and sural nerve biopsy findings in patients with vitamin B12 deficiency 5.
Vitamin B12 Deficiency and Neurological Symptoms
- Vitamin B12 deficiency can cause a range of neurological symptoms, including peripheral neuropathy, myelopathy, and myeloneuropathy 2, 3, 4, 5, 6.
- The studies suggest that early treatment with vitamin B12 supplementation can improve neurological symptoms and electrophysiological parameters 2, 3, 5, 6.
- The underlying mechanisms of vitamin B12 deficiency-related neurological symptoms are thought to involve demyelination and axonal damage in the central and peripheral nervous systems 4, 5, 6.