Differentiating features of UMN and LMN disease

FeatureUpper Motor Neuron LesionLower Motor Neuron Lesion
Site of the lesionCerebral hemispheres, cerebellum, brainstem, spinal cordAnterior horn cell, nerve roots, peripheral nerves, neuromuscular junction, muscles
Muscle weaknessQuadriplegia, hemiplegia, diplegia, paraplegia

Proximal (myopathy)

Distal (neuropathy)

Muscle toneSpasticity, rigidityHypotonia
FasiculationsAbsentPresent (particularly tongue)
Tendon reflexesHyperreflexiaHypo/areflexia

Abdominal reflexes

Absent (depending on the involved spinal level)Present
Sensory lossCortical sensationsPeripheral sensations

Electromyography (EMG)

Normal nerve conduction

Decreased interference pattern and firing rate

Abnormal nerve conduction

Large motor units

Fasciculations and fibrillations

Note. Reprinted from “Concise outline of the nervous system examination for the generalist,” by Jan MM, Al-Buhairi AR, Baeesa SS. Neurosciences (Riyadh). 2001;6:16–22 (https://nsj.org.sa/content/6/1/16). CC BY-NC.