Ayurvedic Management of Progressive Cerebellar Ataxia Associated with Autoimmune Thyroid Disease

Abstract

Cerebellar ataxia is characterized by impaired balance, coordination and motor control and may result from hereditary, degenerative, metabolic, endocrine or autoimmune disorders. Its association with autoimmune thyroid disease, particularly Hashimoto thyroiditis, is uncommon and may occur even after restoration of euthyroidism. Ayurveda considers such neurological manifestations within the broader concept of Vatavyadhi, with Vata, Avarana and Dhatu-kshaya being relevant to the clinical presentation. A 20-year-old male with a seven-year history of hypothyroidism presented with progressive gait imbalance, recurrent falls, impaired coordination, and slowness of speech and writing. MRI of the brain demonstrated diffuse bilateral cerebellar volume loss disproportionate to age, with prominence of cerebellar folia and ex-vacuo dilatation of the fourth ventricle. Thyroid evaluation showed markedly elevated anti-TPO and anti-thyroglobulin antibodies, while testing for common spinocerebellar ataxia repeat expansions was negative. Ayurvedic assessment indicated predominantly Vata-vyadhi with Agnimandya, Ama, Srotodushti, Avarana and Dhatu-kshaya. The patient received individualized multimodal Ayurvedic management comprising internal medicines, Snehapana, Virechana, Abhyanga, Swedana, Nasya, Shiro Pichu, Talapothichil, Pizhichil and Mustadi Rajayapana Basti. The Scale for the Assessment and Rating of Ataxia (SARA) score improved from 13 at baseline to 6 at the time of discharge, with improvement in gait, stance and limb coordination. Multimodal Ayurvedic management was associated with marked functional improvement in this case of cerebellar ataxia with autoimmune thyroid disease. However, being a single case, causality cannot be established and longer-term follow-up is required.