But what would you recommend?

It is very important to examine the patient and especially to see the back of the patient, especially if we have to do with some young patients, relatively young.

And we know from a very recent meta-analysis People with isolated cutaneous stigmata may have occult spinal dysreflexionism in a percentage of 2.8%.

If there is an atypical dimple, maybe this percentage raise 8.8%.

And if we have combined stigmata in the back, the percentage of people that they have occult spinal dysreflexionism is more than 10%.

So it is very important to see the patient, especially if it is a young man or, of course, a woman.

The other important thing, very essential, to see the patient, to watch the patient in the way that he's coming to our office.

So can you tell me how you would approach a patient who has Parkinson's, established, diagnosed, and lower tract symptoms? And in terms of whether you're offering conservative care or surgery to this patient, how would your approach differ in such a patient?