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Long Latency Reflexes in Clinical Neurology: A Systematic Review

Published online by Cambridge University Press:  08 July 2022

Debjyoti Dhar ,
Nitish Kamble  and
Pramod Kumar Pal Open the ORCID record for Pramod Kumar Pal [Opens in a new window]
Debjyoti Dhar
Affiliation:
Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, Karnataka, India
Nitish Kamble
Affiliation:
Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, Karnataka, India
Pramod Kumar Pal*
Affiliation:
Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, Karnataka, India
*
Corresponding author: Dr. Pramod Kumar Pal, Professor, Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore-560029, India. Email: palpramod@hotmail.com
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Abstract:

Background:

Long latency reflexes (LLRs) are impaired in a wide array of clinical conditions. We aimed to illustrate the clinical applications and recent advances of LLR in various neurological disorders from a systematic review of published literature.

Methods:

We reviewed the literature using appropriately chosen MeSH terms on the database platforms of MEDLINE, Web of Sciences, and Google Scholar for all the articles from 1st January 1975 to 2nd February 2021 using the search terms “long loop reflex”, “long latency reflex” and “C-reflex”. The included articles were analyzed and reported using synthesis without meta-analysis (SWiM) guidelines.

Results:

Based on our selection criteria, 40 articles were selected for the systematic review. The various diseases included parkinsonian syndromes (11 studies, 217 patients), Huntington’s disease (10 studies, 209 patients), myoclonus of varied etiologies (13 studies, 127 patients) including progressive myoclonic epilepsy (5 studies, 63 patients) and multiple sclerosis (6 studies, 200 patients). Patients with parkinsonian syndromes showed large amplitude LLR II response. Enlarged LLR II was also found in myoclonus of various etiologies. LLR II response was delayed or absent in Huntington’s disease. Delayed LLR II response was present in multiple sclerosis. Among the other diseases, LLR response varied according to the location of cerebellar lesions while the results were equivocal in patients with essential tremor.

Conclusions:

Abnormal LLR is observed in many neurological disorders. However, larger systematic studies are required in many neurological disorders in order to establish its role in diagnosis and management.

Résumé :

RÉSUMÉ :

Les réflexes de longue latence en neurologie clinique : résultats d’une synthèse systématique.

Contexte :

Les réflexes de longue latence (RLL) sont perturbés dans bon nombre d’états cliniques. L’étude visait à dégager, d’une synthèse systématique de la documentation médicale publiée, les applications cliniques de l’analyse des RLL dans divers troubles neurologiques et les progrès récents réalisés en la matière.

Méthode :

Il s’agit d’un examen de la documentation effectué à l’aide, tout d’abord, d’expressions MeSH bien choisies dans les bases de données MEDLINE, Web of Sciences et Google Scholar, provenant de tous les articles publiés du 1er janvier 1975 au 2 février 2021, puis des termes de recherche suivants : long loop reflex, long latency reflex et Creflex. Les articles retenus ont fait l’objet d’analyse et ensuite de déclaration selon les lignes directrices sur les synthèses sans méta-analyse (SWiM).

Résultats :

D’après les critères de sélection, 40 articles ont été retenus en vue de la synthèse systématique. Les différentes affections comprenaient les syndromes parkinsoniens (11 études; 217 patients), la chorée de Huntington (10 études; 209 patients), la myoclonie d’origine diverse (13 études; 127 patients), y compris l’épilepsie myoclonique progressive (5 études; 63 patients) et la sclérose en plaques (6 études; 200 patients). Des RLL de type II de grande amplitude ont été observés dans les syndromes parkinsoniens, de même que dans la myoclonie de différentes causes. Par contre, il y avait retard ou absence de RLL de type II dans la chorée de Huntington, et retard dans la sclérose en plaques. Parmi les autres affections, les RLL variaient selon le siège des lésions cérébelleuses, et donnaient des résultats ambigus chez les patients atteints du tremblement essentiel.

Conclusion :

Des RLL anormaux ont été observés dans divers troubles neurologiques. Toutefois, il faudrait réaliser des synthèses systématiques de plus grande taille portant sur de nombreuses affections neurologiques afin d’établir leur rôle dans le diagnostic et la prise en charge.

Keywords

Clinical neurophysiologyC-reflexElectromyographyLong latency reflexesLong loop reflexesMovement disorders
Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 50 , Issue 5 , September 2023 , pp. 751 - 763
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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