The tendon reflexes in the Holmes‐Adie syndrome

Abstract

Nine cases of the Holmes-Adie syndrome were studied. The motor nerve conduction velocity in the lateral popliteal nerve was estimated and found to be within normal limits in every case. Isometric tension recordings in the calf muscles confirmed the absence of the ankle jerk. The afferent fibers of the medial popliteal nerve were stimulated using a technique which usually elicits a reflex contraction of the calf muscles (the H reflex). No H reflex was recordable from these subjects although the M wave (produced by direct stimulation of the motor fibers) was present and normal in every case. These results suggest spinal synaptic pathology as the likely cause of the absent tendon reflexes in this condition.