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The True Sign of Babinski.

To the Editor.--We read with interest the paper written recently by Jay on the Sign of Babinski.(1) We agree that Babinski did "his most famous communication on the reflex only 28 lines long."(1) However, we disagree with Jay on the correlation between this communication and the so-called Babinski sign; Joseph Babinski never called the upgoing toe as such. He actually called the extensor plantar reflex "the great toe sign," and what he called the Babinski sign was the failure of the platysma muscle to contract on the side of a hemiparesis.(2) Unfortunately, the mistake remains up to recent times supported by some researchers, who increase the confusion by interexchanging the terms sign and reflex in the same paper. That is why we recommend maintaining the term Babinski sign as described originally and using Babinski reflex for "the great toe sign."(3) It should also be remembered that "the great toe sign," or the Babinski reflex, does not mean a disturbance of the pyramidal tract itself, as usually thought, because this reflex could be present in patients with pure peripheral neuropathies, such as the Guillain-Barre syndrome, as well.(4) We want to stress that heretofore we must give the appropriate credit and meaning to original descriptions in the medical sciences field to avoid more misunderstandings in this new century of evidence-based medicine.

FIDIAS E. LEON-S, MD,PhD Department of Internal Medicine and Basic Sciences UiS-Universidad Industrial de Santander Bucaramanga, Colombia

LUIS J. PRADA, MD Clinical Group in Forensic medicine and Epidemiology INML & CF, National Institute of Forensic Medicine'Bogota, Colombia

(1.) Jay V. The sign of Babinski. Arch Pathol tab Med. 2000;124:806-807.

(2.) Rolak LA. Neurology Secrets. 2nd ed. Philadelphia, Pa: Hanley & Belfus; 1998:388.

(3.) van Gijn J. The Babinski reflex. Postgrad Med J. 1995;71:645-648.

(4.) Ropper AH. The Guillain-Barre syndrome. N Engl J Med. 1992;326:1130-1136.

In Reply. -- I thank Drs Leon-S and Prada for their interest in my profile of Dr Babinski. My article was intended as a general biographical sketch, wherein I tried to present to the reader some highlights of the extraordinary career of this great neurologist.

In the text of my article, I have spoken of Babinski and the plantar reflex and have outlined some of "Babinki's own observations" on the plantar response in various conditions including a disturbance of the pyramidal system. Drs Leon-S and Prada are objecting to the title, "The Sign of Babinski," which was a literary choice on my part for a title. I am quite open to and welcome their comments, but believe that there is no fundamental inaccuracy in the text of my article as a reflection of the life and work of Dr Babinski.

VENITA JAY, MD,FRCPC Division of panthology the Hospital for Sick Children Toronto, Ontario, Canada M5T 2W9
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Publication:Archives of Pathology & Laboratory Medicine
Article Type:Letter to the Editor
Date:Jun 1, 2001
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