The pathogenesis of Hirayama disease is usually attributed to microcirculatory disturbances in the anterior spinal artery territory, leading to segmental anterior horn cell loss and occasional lower limb hyperreflexia. In 7 patients with Hirayama disease, central motor conduction to upper (CMCT-ADM) and lower limbs (CMCT-TA) was evaluated. CMCT-TA was normal in all, but CMCT-ADM was marginally prolonged (8.4 msec, amplitude 0.8 mV) on one side only. Peripheral delay in the upper limbs was found in 2 patients (1 side each) which might be due to fall-out of anterior horn cells. In 2 patients with lower limb hyperreflexia, HM ratio, vibratory inhibition and reciprocal inhibition of soleus H reflex were also normal, suggesting lack of pyramidal dysfunction. Our results do not suggest any pyramidal dysfunction as a cause of lower limb hyperreflexia in Hirayama disease.