Introduction

The word Ataxia is derived from Greek word “A-Taxia”, ‘A’-lack/absence and ‘Taxia’- coordination, which means lack of order or coordination. Ataxia is a neurological sign that manifests as lack of coordination in the movement of different muscles in the body.

Cerebellar Ataxia^[1] is an uncoordinated muscle movements with loss of balance mainly due to lesions in the cerebellum.

Figure 1:

Causes can be Inherited and acquired explained in Fig 1. Inherited forms may present at birth or manifests later. It may be Autosomal recessive or Autosomal dominant. Acquired causes includes Infection- bacterial or viral, Tumors, Trauma, Stroke, Auto immunity, Toxins like mercury, thallium, toluene, Drug induced – Lithium, Phenytoin, Calcineurin inhibitors, Thyroid disorders includes - Hypothyroidism and Hypoparathyroidism, Nutritional causes- Vitamin B12 and E deficiency, Alcohol intoxication. Symptoms of Cerebellar Ataxia includes Ataxic gait, Nystagmus, Dysmetria, Dysdiadochokinesia, involuntary-rhythmic tremors, positive Rebound phenomenon, Hypotonia, Dysarthria. There is no proven therapy for SCA. Aims of management often includes to identify treatable disease entities, to reduce hypotonicity-dysmetria-dysdiadochokinesia, to improve muscle strength and increase ROM, to prevent secondary complications.

Case Report

A 25 year aged female patient came with the complaints of weakness in both lower limbs and difficulty in walking since 10 years.

History of Present illness

Patient was apparently asymptomatic before 15 years. She was having left eye squint since birth, but was fine with her vision initially,

Clinical findings

• Built - moderately built
• Nourishment - moderately nourished
• Wt - 53kg, Ht - 129cm, BMI - 31.8
• Pallor - Absent
• Icterus - Absent
• Clubbing - Absent
• Cyanosis - Absent
• Lymphadenopathy - Absent
• Edema - Absent

Ashtavidha Pareeksha

• Nadi (~pulse) - Vata-Pittanubandha
• Mala (~bowel habits) - Irregular
• Mutra (~urination) - Prakruta
• Jihwa (~tongue) - Alipta
• Shabda (~voice) - Prakruta
• Drik (~vision) - blurred vision, Nystagmus+
• Sparsha (~touch) - Anushna Sheeta
• Akriti (~ body built) - Madhyama

Dashavidha Pareeksha

• Prakruti - Vata Pittanubandha
• Vikriti - Vata Kapahaja
• Sara - Madhyama
• Samhanana - Madhyama
• Pramana - Madhyama
• Sathmya - Katu Rasa Pradahana Sarvarasa
• Satwa - Madhyama
• Aharashakti - Madhyama
• Vyayamashakti - Avara
• Vaya - Bala

Systemic examination:

• CVS: S1,S2 heard, no murmur
• RS: B/L symmetrical, normal vesicular breath sounds heard, no added sounds.
• GIT:

• Inspection: umbilicus inverted and central.
• Palpation: Soft, no tenderness, no organomegaly.

Materials and Methods

Source of data:

Patient suffering with Cerebellar Ataxia is selected from IPD of Sushruta Ayurvedic medical college and Hospital Bangalore.

Study design: A Single Case Study

Differential diagnosis:

Table 2: Vyavachedaka Nidana

Outcome:

After Sarvanga Abhyanga and Sweda patient felt better and replenished. Improvements were assessed based on clinical features and SARA score^[2] before and after treatment. After the course of Basti patient was able to walk for short distance without support and leaning. No adverse events occurred during the treatment course.

Discharge advice:

• Brihat Vata Chintamani Rasa^[3] (1-0-1)
• Ashwagandharishta^[4] (3tsp-0-3tsp)
• Aja Mamsa Rasayana^[5] (1tsp-0-0) with 1 glass of warm milk

Table 6: Scoring pattern SARA Scale before and after treatment.

It is a potent brain tonic and stimulator and declines oxidative stress thereby enhancing memory, reasoning and cognitive behaviour. This polyherbal formulation also improves the immune system and shielding body against the infections.

Brihat Vata Chintamani Rasa is a herbomineral preparation contains Bhasma of Swarna, Roupya, Abhraka, Loha, Pravala, Mouktika and Rasa Sindhura. Formulation is mainly Rasayana (~rejuvenative therapy), Vatarogahara, Balya, Ayuvardhaka etc., Bhasma in the form of nano particles is easier to pass Blood brain barrier, Gold nanoparticles have an effect on upregulation of anti-apoptotic proteins and down apoptotic proteins. Silver nanoparticles help in reduction of inflammatory response. Magnetic nanoparticles act as reactive oxygen species inducers and scavengers in brain cells. Calcium nanoparticles regulate the calcium channel and presynaptic plasticity in nerve cells. Rasa Sindhura suppresses the neurodegeneration by assisting in protein clearance.

Sarvanga Abhyanga with Nirgundi Taila followed by Bashpa Sweda Niruha with Dashamoola Ksheera Niruha - Basti is the main line of Chikitsa for Vatavyadhi. By giving Basti there will be both procedural effect and drug effect.

Since Gastro intestinal tract has its own nervous system called Enteric nervous system. Basti given through rectal route stimulate the nervous system and drug absorption depends on the physicochemical properties of the formulation. In rectum drugs may pass cell membranes by passive diffusion, facilitated passive diffusion and active transport. Dashamoola are the best Vatahara Dravya. In order to achieve both Sroto Shodhana (~cleansing of the channels) and Brimhana (~bulk promoting) action, Dasamoola Ksheera Niruha Basti was given.

Dhanwantaram Taila has multifaceted therapeutic application. Dhanwantaram Taila mainly indicated in all kinds Vatavyadhi. Majority of the ingredients are Vatahara, Balya, Srotoshodhana, Brimhana and Rasayana property.

Aja Mamsa Rasayana has been explained in Sahasrayoga Parishishta Prakarana, has indication in Vatavyadhi. Majority of the ingredients this formulation contains are Vatarogahara, Balya, Rasayana. Since Ajamamsa is nutrient dense and richest source of Thiamine, vitamin B6 and B12,