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• The palmomental reflex: Reply to Schott and Rossor
  Andrew J Lees
  Published on: 20 December 2016

• Published on: 20 December 2016

  The palmomental reflex: Reply to Schott and Rossor

  • Andrew J Lees, Dr

  Dear Editor,

  The only thing that I can disagree with in Jonathan Schott and Martin Rossor's article on the palmomental reflex in the December issue of Practical Neurology is their plea that I should stop scraping. I have found that the palmomental reflex can be made more specific for detecting brain damage by applying the orange stick or car key to the hypothenar rather than the thenar eminence. A positive palmomen...

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  Dear Editor,

  The only thing that I can disagree with in Jonathan Schott and Martin Rossor's article on the palmomental reflex in the December issue of Practical Neurology is their plea that I should stop scraping. I have found that the palmomental reflex can be made more specific for detecting brain damage by applying the orange stick or car key to the hypothenar rather than the thenar eminence. A positive palmomental reflex sign is present if there is a mentalis twitch in at least seven out of ten successive scratches.

  While I agree that the test has no role in the diagnosis of dementia or Parkinson's disease it may still have useful application in the investigation of psychosis and obsessional compulsive disorder. A positive quantitative palmomental reflex in a person under 60 would make me consider neuroimaging to look for structural cerebral abnormalities.

  Similar caveats to those put forward by Schott and Rossor for the palmomental reflex apply to the glabellar tap (Myerson's sign). It is an accoutrement that impresses patients but is redundant in the evaluation of Parkinsonism. However, there are instances where it can be helpful. Some years ago I saw a woman of 45 who presented with physical fatigue. She had a hangdog posture, a monotonous voice, did not swing her arms when walking and had a sad face. She had seen several physicians already and carried the label of chronic fatigue syndrome. On examination she had a positive glabellar tap sign. When she returned for follow up a few months later she had developed a clear sequence effect (motor decrement) on finger tapping and I made a firm diagnosis of Parkinson's disease. Primitive reflex testing is quick and simple and may still have a place in the research screening of normal elderly people for neurological disease. I will continue to teach the palmomental reflex and the glabellar tap sign to medical students but emphasise the limitations highlighted by Schott and Rossor. Perhaps the Editors will consider a neuromythology series on useless research scales and operational criteria for the diagnosis of neurological disease when the physical signs series is completed?

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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