title: Intact thumb reflex in areflexic Guillain Barré syndrome: A novel phenomenon.
abstract: BACKGROUND
  Areflexia is one of the cardinal clinical features for the diagnosis of Guillain Barré syndrome. However, some patients may have sluggish proximal muscle stretch reflexes. Presence of thumb reflex, a distal stretch muscle reflex has not been documented in Guillain Barré syndrome.
  
  
  METHODS
  We prospectively evaluated thumb reflex in Guillain Barré syndrome patients and age matched controls from April to September 2013.
  
  
  RESULTS
  There were 31 patients with Guillain Barré syndrome in whom thumb reflex could be elicited in all (24 brisk, 7 sluggish), whereas all the other muscle stretch reflexes were absent in 29 patients at presentation and the remaining two had sluggish biceps and quadriceps reflexes (P = 0.001). Serial examination revealed gradual diminution of the thumb reflex (P < 0.001). Rapid progression of weakness was associated with early loss of the thumb reflex.
  
  
  CONCLUSIONS
  Thumb reflex, a distal stretch reflex is preserved in the early phase of Guillain Barré syndrome.
authors.affiliation: Department of Neurology, KLES' Dr Prabhakar Kore Hospital and Medical Research Centres, Belgaum, Karnataka, India ; Department of Neurology, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Karkal Ravishankar
authors.initials: KR
authors.lastname: Naik
authors.affiliation: Department of Neurology, KLES' Dr Prabhakar Kore Hospital and Medical Research Centres, Belgaum, Karnataka, India ; Department of Neurology, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Aralikatte Onkarappa
authors.initials: AO
authors.lastname: Saroja
authors.affiliation: Department of Neurology, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Manik
authors.initials: M
authors.lastname: Mahajan
keywords: Acute flaccid paralysis; Guillain Barré syndrome; muscle stretch reflex; thumb reflex