Introduction

Spastic ataxic syndrome involves concurrent dysfunction of the pyramidal and cerebellar systems, resulting in increased muscle tone, exaggerated reflexes, impaired coordination, and an unsteady gait. Spinocerebellar Ataxia Type 1 (SCA1), the most common autosomal dominant form of hereditary ataxia worldwide, frequently presents with a combination of gait ataxia, limb incoordination, spasticity, dysarthria, oculomotor abnormalities, and extrapyramidal signs such as dystonia or parkinsonism. Some patients may also exhibit peripheral neuropathy or mild cognitive impairment. Early clinical recognition, supported by neuroimaging and genetic testing for ATXN3 mutations, is crucial for confirming the diagnosis, guiding symptom management, and providing genetic counselling to at-risk family members. Treatment focuses on managing the underlying cause and supportive therapies like physiotherapy and speech therapy to improve functional outcomes. In ayurveda it is classified under Vatavyadhi and Vatahara Chikitsa is adopted to reduce the severity and progression of the disease.

Case Report

A 39-year-old female patient who complaints of shivering all over the body, difficulty in walking, speech difficulty and muscle cramps. 4 years before she noticed insidious onset of walking difficulty while climbing down from foot board of bus. Later she felt difficulty in walking through narrow passages and climbing upstairs. She had tremulousness while approaching objects like a cup of tea and is not able to write properly as before. She was under allopathic medication and was taking Evion 400mg tablet twice daily, Admenta tablet and Gabapentin tablet once daily. Whenever she doesn’t take the medicine, her symptoms aggravated. Without any help she can’t walk properly. Shivering also presented throughout the body. So, she came for ayurvedic management.

Past history of illness

No history of DM, HTN and DLP
Neurological examination

Clinical Finding

HMF - Intact
Cranial nerves

Prakruthi - Vata Kapha

Vaya - Madhyama

Satwam - Madhyama

Satmya - Sarvarasa satmya

Nidana Panchakam

Hetu - Beeja Dosha, Athi Yana Adhwa, Chinda

Poorva Rupa - Avyakta

Rupa - walking imbalance, slurred speech, shiver-ing all over the body, muscle cramps

Samprapti - Due to Nidana Seva → Vata Prakopa → causes Kha Vaigunya in Srotas → Lakshanas are produced

Upashaya - Sheetopachara

Diagnostic criteria

The case was previously diagnosed as SCA 1: Genotype – 28 / 50± 3 based on molecular genetic analysis for spino cerebellar ataxia (triplet repeat disorder). Her MRI brain shows bilateral cerebellar atrophy. For assessment SARA scale was taken. Routine investigations were done.

Intervention

Treatment was done in two phases. Firstly, Rookshana Chikitsa was done through Udwarthana with Kolakulathadi and Jeevanthyadi Churnam followed by Utsadana with Jeevanthyadi Churna and Dasamoola Churna with Ksheera and Dhadhi. Internally Rookshana was done with Panchakola Churna. Once Samyak Rooksha Lakshana was attained Snehapana was carried out using Rasnadasamoola Ghrita and Shadpala Ghrita for 6 days (total quantity Sneha Matra on last day 180 ml). Then Abhyanga and Ooshma Sweda was done for 3 days followed by Virecana using 2 Misraka Sneha soft gel capsule. Secondly after Samsarjana Karma patient was subjected to Navadhanyakizhi, Nasya, Pizhichil, Shiro-Picchu, Shiro-Vasti, Ksheeravasti and Pratimarshanasya. Thalam with Mahamasha Tailam and Kachooradi Churnam was done throughout the treatment at 4pm.

Assessment

Improvement of patient was assessed using SARA scale before starting treatment and after completion of treatment. Marked improvement was seen after treatment as shown in Table^[1]

• Shodhanatha Snehapana was carried out to produce Deepta Antaragni (profound digestion), Pratyagra Dhatu(enlivened tissues), Bala (physical strength) and Dridendriya (stable senses).^[6]
• Rasanadasamoola Gritham is beneficial in Sarva Vathaamaya^[7] and Shatpala Ghrita clears the channels (Srotasam Vishodanam).^[8]
• Virechana causes balance of Agni and Doshas; and Nasya was given to strengthen the Urdwa Jatru and for Indriya Prasadana
• Asthi and Majja is the seat of Vata also Asthi and Vata have Ashraya Ashrayi Sambandha. Ksheera Basti nourishes the Asthi Dhatu and there by pacifies its Ashrayee Vata Dosha.^[9]
• Nava Dhanya Kizhi has Vatahara property and is good for curing neurological conditions
• Shirobasti has been reported to be having an excellent result on such disorders as it gives strength to the central nervous system. It calms down both the mind and the senses which allow the body' s natural healing mechanism to release stress from the nervous system by pacifying Vatadosha, particularly Pranavayu. The procedure of Sirovasti imparts benefits of both Snehana and Swedana^[10]

Conclusion

Currently there is no definitive management for spastic cerebellar ataxia. SCA symptoms are often seen as an imbalance of Vata Dosha, especially affecting Majja Dhatu (nervous tissue) and Sira (nerves). So Vatahara line of treatment is adopted. The treatment mainly focuses on symptomatic management, slowing disease progression and improving the quality of life. The patient shows subjective improvement in walking, there was significant improvement in overall balance, speech and power after the treatment.

References