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Related Experiment Videos

Undulating toe movements in brain death.

G Saposnik1, J Mauriño, R Saizar

  • 1Movements in Brain Death Study Group, Department of Neurology, Hospital JM Ramos Mejía, Universidad de Buenos Aires, Buenos Aires, Argentina. gsaposnik@yahoo.com

European Journal of Neurology
|November 5, 2004
PubMed
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Undulating toe flexion movements (UTF) are common in brain death (BD) patients, occurring in 23% of cases. Early evaluation predicts UTF, a spinal reflex that does not preclude BD diagnosis or organ donation.

Area of Science:

  • Neurology
  • Neurosurgery
  • Critical Care Medicine

Background:

  • Spontaneous or reflex movements (SRMs) have been anecdotally reported in patients with brain death (BD).
  • The presence of SRMs can complicate the diagnosis of BD and impact organ donation for transplantation.
  • Undulating toe flexion (UTF) movements, a sequential brief plantar flexion of the toes, have been previously described in BD patients.

Purpose of the Study:

  • To determine the frequency, characteristics, and predisposing factors of UTF movements in a prospective multicenter cohort study of patients with BD.
  • To clarify whether UTF movements preclude the diagnosis of BD and affect organ donation potential.

Main Methods:

  • A prospective multicenter cohort study involving 107 patients with confirmed BD diagnosis according to AAN requirements.

Related Experiment Videos

  • Standardized assessment for UTF movements, routine laboratory evaluation, CT scan of the head, EEG, SSEPs, and BAEPs.
  • Analysis of demographic, clinical, hemodynamic, and blood gas concentration factors as potential predictors of UTF.

    • Main Results:

    • 47% of BD patients exhibited abnormal movements, with UTF being the most common (23% of all BD patients, 53% of those with abnormal movements).
    • Early evaluation was identified as a significant predictor of UTF (OR 4.3, CI95% 1.5-11.9) in a multivariate regression model.
    • SSEPs and BAEPs did not elicit a cortical response in patients with UTF, suggesting a spinal cord integrated reflex (L5 and S1 segments).

    Conclusions:

    • Abnormal movements, particularly UTF, are common in BD patients and do not preclude the diagnosis.
    • Early evaluation is a predictor of UTF, highlighting the need for awareness among healthcare professionals involved in organ procurement.
    • UTF is a spinal reflex that should be recognized and differentiated from other neurological signs when assessing BD.