Hyperreflexia in outpatients with Parkinson’s disease and coexisting cervical spinal stenosis: A retrospective cohort study

Background. Degenerative cervical myelopathy (DCM) is poorly recognized and infrequently diagnosed. Objectives. To identify symptoms and signs in the lower extremities physically and radiologically in outpatients with idiopathic Parkinson’s disease (PD) and coexisting DCM. Methods. In 2023, a retrospective cohort study was performed to review the medical records from 2016 to 2020 at the outpatient clinic of the Department of Internal Medicine. As a result, 8 women with PD were diagnosed based on the presence of cardinal features, asymmetry, and a good response to levodopa. Brain and cervical magnetic resonance imaging (MRI) was conducted in 4 patients (group A): 3 with hyperreflexia of the patellar tendon, and 1 with Babinski’s sign. Results. The motor subtype of the 8 patients aged 69 to 90 was a tremor-dominant type of PD. The Hoehn and Yahr (H&Y) stages were II (1) and III (3) in group A, and III (3) and IV (1) in those without hyperreflexia of the patellar tendon. Hyperreflexia and Babinski’s sign were predominant on the tremor-dominant side in group A. Radiologically, their anteroposterior diameters at the most stenotic level (C5-6) were 6.0, 7.1, 7.1, and 10.4 mm. They developed muscular rigidity and spasticity involving the lower extremities. The gait and balance performance were particularly affected compared with the upper extremity function. Conclusion. Hyperreflexia of the patellar tendon and imbalance of gait performance due to coexisting DCM were the important factors affecting gait in older women with tremor-dominant PD.