By John D. England, MD
John D. England, MD
The Journal of the Neurological Sciences (JNS) is a broad-based journal which publishes articles from a wide spectrum of disciplines, ranging from basic neuroscience to clinical cases. In an upcoming issue of JNS, we will be acknowledging our peer reviewers. The individuals whose names appear in the list have provided peer reviews of manuscripts which were submitted to JNS during the past year. This elite group of individuals from around the world includes some of the best and brightest minds in neuroscience and clinical neurology. They receive no remuneration for their work for the journal and take time from their busy schedules to review our articles. All of the associate editors and I thank them for their indispensable work. The journal would not survive without their expert advice. I express my most sincere gratitude to all of the reviewers. They inform and enlighten all of us in the editorial office and help to make JNS a journal of the highest quality.
In our ongoing attempt to enhance accessibility of JNS articles to members of the World Federation of Neurology (WFN), we have selected two “free – access” articles, which are profiled in this issue of World Neurology.
In this issue, we feature two paired articles regarding the diagnostic accuracy of the famous Babinski sign:
- Despite its legendary status, controversy exists regarding the diagnostic accuracy and usefulness of the Babinski sign in determining pyramidal tract dysfunction. Much of the variability in the assessment of the diagnostic accuracy of the Babinski sign is due to studies which do not follow simple but important methodological standards. The paper by S.P. Isaza Jaramillo, et al. is exceptional in this regard. This paper describes a simple but methodologically rigorous study to ascertain the diagnostic accuracy of the Babinski sign for identifying pyramidal tract disease. One hundred and seven (107) patients with limb weakness were assigned a random identification number for blinding purposes. Two neurologists elicited a plantar response in each patient in a standardized manner. The examination was performed in a blind and independent manner, and each examination was filmed to quantify intra-observer variability. The reference standard for diagnosis of pyramidal tract dysfunction was provided by a senior neurologist who examined every patient independently and had available the patient’s history, complete neurological examination, laboratory and neuroimaging results. Compared to the reference standard, the Babinski sign had a very high specificity of 99 percent (CI 97.7-100), but moderately low sensitivity of 50.8 percent (CI 41.5-60.1) in identifying pyramidal tract dysfunction. These findings indicate that a Babinski sign elicited in a standardized manner by an experienced practitioner has high diagnostic accuracy for identifying pyramidal tract disease. However, in view of the low sensitivity, the absence of a Babinski sign does not rule out pyramidal tract dysfunction. Jaramillo SPI, Uribe CSU, Jimenez FAC, Cornejo-Ochoa W, Restrepo JFA, Roman GC. Accuracy of the Babinski sign in the identification of pyramidal tract dysfunction. J Neurol Sci 2014;343:66-68.
- In an editorial in the same issue of JNS, Austin Sumner provides an historical perspective on the Babinski sign and discusses the more recent controversy concerning its diagnostic usefulness. He concludes that the “confidence traditionally placed by clinicians on this simple test is justified” with the caveat that its absence does not rule-out pyramidal tract disease. Sumner AJ. The Babinski sign. J Neurol Sci 2014;343:2.
