What does it mean by to have abnormal reflexes at patella and Achilles in a 37-year-old male?

Hello doctor,

Thank you very much for your time. I am a 37-year-old male who is looking for clarification related to a recent neurology workup I received. I own a business in the medical field, so I have a lot of contacts locally, one being at a neurology institute. I made an appointment with a very experienced neurologist when I began feeling intermittent vibrating or a buzzing in my left calf. It was like a cell phone was going off. There were no other symptoms other than that. During my neurological exam, it was noted that everything was normal with the exception of two areas in my legs. I was hyper-reflexive at the patella and the Achilles, and the Achilles actually elicited some beats of clonus. All other reflexes were normal. The calf buzzing has for the most part gone away. Naturally, these reflex findings threw me into a frenzy even though the neurologist stated this was nothing more than a mechanical issue stemming from my cervical spine. Cervical and thoracic MRIs (magnetic resonance imaging) were conducted, as well as an SSEP (somatosensory evoked potential), blood tests, EMG (electromyography), and nerve velocity conduction test. All came back normal with the exception of a finding at C5/C6 of mild spinal stenosis and posterior disc bulging with herniation "in the midline", which is more eccentric to the right. My neurologist gave zero options of even discussing anything else that could be causing the abnormal reflex responses. He stated that we will rescan the area in one year and watch for any further progression. I take vitamin D, K supplements, and tablet Xanax as needed for anxiety.

My questions are two-fold given in the following:

1) With this information, can I rest assured that these two findings are being caused by my mild cord encroachment?

2) Are these types of abnormal reflexes ever a primary manifestation of an MND (motor neuron disease) previous to any signs of weakness or atrophy? I have not been able to find such data anywhere that will answer this question. I assume not because there is already an abnormality present in the reflex arc, so certainly if another condition were present, it would have been picked up elsewhere.

Thank you.

Hello doctor,

Thank you for the reply.

My second question was more in relation to the hyperreflexia of the patella and Achilles. With the MRI findings at C5/C6, would mild stenosis and a midline disc herniation be the certain cause for this? Also, is hyperreflexia of this type ever a primary manifestation of a motor or CNS (central nervous system) disease process, or do these responses always appear secondary after weakness or atrophy, or disease progression?

Thank you.

Hello doctor,

Thank you for the reply.

One last thing I want to ask. A very basic layman's question relating to your answer. To clarify, if one has hyperreflexia in both lower limbs, that will always be caused by a condition currently presenting in the body as stenosis, thyroid, muscle spasms, etc. It will never be a primary presentation that will then evolve into a systemic disorder. Please confirm if this is accurate.

Thank you.