Arwas N, Leshno A, Gotkine M
a Department of Neurology , Hadassah-Hebrew University Hospital , Jerusalem , Israel.
Amyotroph Lateral Scler Frontotemporal Degener. 2018 Nov;19(7-8):513-515. doi: 10.1080/21678421.2018.1497064. Epub 2018 Oct 9.
The palmomental reflex (PMR) is a primitive reflex, which may appear when cortical inhibitory pathways are disrupted by disease. In this study, we examined whether the PMR is associated with corticobulbar involvement in people with ALS (PALS).
PMR was routinely tested for each patient attending the ALS clinic. Three hundred and eighteen consecutive PALS were included, of whom 271 were PMR positive (PMR+). Clinical evaluation defined the presence of upper motor neuron (UMN) and lower motor neuron (LMN) signs in the bulbar, cervical and lumbosacral segments.
The PMR + group had a higher rate of both UMN and LMN bulbar involvement (BI) as well as more UMN upper-limb involvement and UMN involvement of any type, the strongest association being between PMR + and UMN BI. In patients without BI at presentation, UMN BI developed roughly 15 months early in the PMR + group compared to the PMR- group.
We found that the PMR is strongly associated with UMN signs within the bulbar region and to a lesser extent with upper-limb UMN involvement. We propose the PMR be considered a harbinger of corticobulbar involvement in PALS.
掌颏反射（PMR）是一种原始反射，当皮质抑制通路因疾病而中断时可能会出现。在本研究中，我们研究了PMR是否与肌萎缩侧索硬化症（ALS）患者（PALS）的皮质延髓受累有关。
对在ALS诊所就诊的每位患者常规检测PMR。纳入318例连续的PALS，其中271例PMR阳性（PMR+）。临床评估确定延髓、颈段和腰骶段上运动神经元（UMN）和下运动神经元（LMN）体征的存在情况。
PMR+组UMN和LMN延髓受累（BI）的发生率更高，UMN上肢受累以及任何类型的UMN受累也更多，最强的关联是在PMR+和UMN BI之间。在初诊时无BI的患者中，与PMR-组相比，PMR+组UMN BI的出现大约早15个月。
我们发现PMR与延髓区域的UMN体征密切相关，与上肢UMN受累的相关性较小。我们建议将PMR视为PALS中皮质延髓受累的先兆。
