Epistemis

Hyperreflexia

Specialty: Neurology.

  • exaggerated reflexes
  • vivid reflections
  • osteotendinous reflex hyperactivity

Why it occurs

  • Cervical spondylotic myelopathy (chronic spinal cord compression due to osteoarthritis/hernias)
  • Amyotrophic Lateral Sclerosis (ALS, with first and second motor neuron signs)
  • Old cerebrovascular accident (spasticity phase and late pyramidal release)
  • Multiple sclerosis (demyelination plaques in the corticospinal tract)
  • Hypoxic-ischemic encephalopathy or infantile cerebral palsy
  • Toxicity due to serotonin syndrome or withdrawal from CNS depressant drugs

Initial workup

Physical examination to look for an enlarged reflexogenic area, diffusion of reflexes and the presence of pathological clonus (in the ankle or patella); MRI of the cervical/dorsal spine to rule out structural compressive myelopathy; Brain MRI if cortical or subcortical brain lesions are suspected; analysis with electrolyte levels.

red flags

Generalized hyperreflexia of acute or subacute onset accompanied by inexhaustible clonus, nuchal rigidity, fever, agitation and myoclonus, suggestive of serotonin syndrome or acute disseminated encephalomyelitis (ADEM).

Standard management

  • Baclofen — 10-60 mg/day to modulate spinal excitability
  • Tizanidine — 2-12 mg/day
  • Clonazepam — 0.5-2 mg at night, useful if hyperreflexia is accompanied by annoying nocturnal muscle spasms
  • Immediate suspension of serotonergic triggering agents if drug toxicity is suspected.

Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.

PreviousHyperesthesia
Area
Neurology
Listed causes
6
Treatment options
4
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