Exploring Alternative Medicine
We can relate big time. Gait, balance, hand coordination, vision, speech, swallowing, mild cognitive impairment, and fatigue are just a few problems related to cerebellar ataxia that develops because of cerebellar degeneration. Gary’s cerebellar atrophy was diagnosed as mild in 2014 but still dropped a variety of symptoms directly in our lap.
Vision issues have made driving no longer possible. Speech, swallowing, and coordination problems seem to intensify with fatigue. Cognitive issues are evening out as of late so being the glass half full part of this partnership I’m going to chalk that up to some positive effect of the green tea. As for mood, well we’ve been married 37 years, so we deal with that in our way.
We hope to avoid going down the overmedicated prescription road. That’s not to say if a conventional western medication turns out to be something necessary we’d turn away from it. Still, we’re hoping to explore any natural or alternative medicine that might offer some relief. One of these alternative medicine disciplines is Ayurvedic medicine.
Ayurveda is a 5,000-year-old discipline of physical healing that originated in India. Traditional Tibetan and Chinese Medicine can both trace their roots back to Ayurveda and the philosophy of Mind, Body, and Spirit.
In 2009 a joint study in India was conducted by the Department of Neurology, National Institute of Mental Health and Neurosciences, Advanced Ayurvedic Research Unit, National Institute of Mental Health and Neurosciences and Psychiatric and Neurological Rehabilitation, National Institute of Mental Health and Neurosciences. In this study, they sought to discover if traditional Ayurvedic medicine could have a positive effect on balance issues caused by cerebellar ataxia.
Comprehensive treatment of progressive cerebellar ataxias has remained elusive to a large extent. There are as yet no approved drugs or disease-modifying therapies for this problem and till date, there is no documented Allopathic treatment effective for cerebellar ataxias. Ayurveda describes this condition as kaphavrita vyana vata (occlusion of vyana vata by kapha dosha) under vata vyadhi (neurological diseases) and specific treatment regimens have been described to combat the various symptoms seen in the course of the disease. The aim of this study was to assess objectively the improvement in balance in progressive degenerative cerebellar ataxias following one such mode of treatment.¹
They chose ten patients for their study between the ages of 12 and 60 who all had progressively worsening cerebellar ataxia and had failed to show any improvement from any previous treatments. A combination treatment was applied. Shirobasti for the men ( warm oil on the head/scalp)or Shirodhara (warm oil on the forehead) for the women for a length of 45 minutes. Full body massage and 10-15 minutes of sitting in a Bhashpa svedana yantra (customized wooden box) with vapors warm enough to induce sweating. Treatments were administered daily for 14 consecutive days.
The subjects were prescribed: Two Dhanvantaram capsules 101 soft gel three times a day, One Ashwagandha 500mg three times a day and 15 ml Maharasnadi kashayam three times a day for a 30-day period.
(You can read a detailed description of this herbal treatment in our article: Exploring Ayurveda For Cerebellar Ataxia And Pain Control)
“In this study, we have reported our preliminary observations of the effect of Ayurvedic treatment in patients with degenerative cerebellar ataxia. Though molecular genetic research has completely revolutionized the way in which the progressive cerebellar ataxias are classified and diagnosed, it is yet to produce effective gene-based, neuroprotective, or neurorestorative therapies.  With due acknowledgement of the limitations of open-label study on a small heterogeneous group of progressive degenerative ataxias, we report encouraging observations in treatment of this debilitating disorder for which there is no effective therapy till date. Though Ayurvedic treatment has been reported to be effective in other neurodegenerative conditions, such as Parkinson’s disease,  to the best of our knowledge, there are no reports of similar beneficial treatment in progressive degenerative cerebellar ataxias.
While before treatment all the patients had one or more abnormal balance indices, following treatment, 40% of patients showed normal balance indice.
Dynamic posturography and BBS have been validated in earlier studies. ,, In our study, there was an objective improvement in balance after one month of Ayurvedic therapy. While before treatment all the patients had one or more abnormal balance indices, following treatment, 40% of patients showed normal balance indices (all three). The mean values of OBI and API also significantly improved after treatment. The MLI was normal in eight patients prior to the treatment. In the remaining two patients, the mean MLI improved after treatment (3.8 ± 1.98 to 2.3 ± 0.99). On the contrary, we did not observe any significant change in the LOS parameters.
Ayurveda stresses on a holistic approach to diseases, and hence, treatment is aimed at both the dosha (causal factor) and the vyadhi (disease). The Ayurvedic treatment administered in the present study is also on similar lines. Predicting the exact mode of action of the treatment is not feasible due to the complexity of the treatment regimen. However, a hypothesis on the possible mode of action has been postulated based on the descriptions in Ayurvedic classics and existing literature on these therapies. ,,,,,,,,
Shirodhara , Shirobasti, Abhyanga, and Svedana are balya (promote strength) and vatahara (pacify morbid vata ). Svedana also aids kaphaharana (pacifies morbid kapha ). This promotes samprapti vighattana (undoing the pathogenesis) and plays a crucial role in bringing about the desired result. Therapeutic oil massage is known to promote growth and development in neonates via transcutaneous absorption of the nutrients. ,, These therapies enhance muscle power and thus may have contributed to the improved performance in the balance parameters. Oxidative stress plays a vital role in the pathogenesis of such degenerative disorders of the brain.  Thermal therapy is known to enhance antioxidant functions such as the activities of superoxidase dismutase. Hence, Svedana procedure may also have facilitated a similar action. Shirodhara has been shown to have anxiolytic, sympatholytic, and immunopotentient effects on patients of anxiety. , A possible reduction in the anxiety coupled with other effects may have resulted in better performance. Ashvagandha (Withania somnifera Linn.), Bala (Sida cordifolia Linn.), and other ingredients in Maharasnadi kashayam are known antioxidants,  and thus may contribute to prevent and/or revert the pathogenesis. Bala is also the chief ingredient of Dhanvantaram tailam . Krishnamurthy and Telles reported improvement in the mobility, as assessed by timed up and go (TUG) test in older people (60-95 years), after treatment with a polyherbal formulation containing Ashwagandha and Bala.  The authors attributed this to a possible improvement in the muscle strength, similar to that reported in Ayurvedic classics.
In summary, the present study is a preliminary report of the objective evaluation of the efficacy of Ayurvedic therapy in improving balance. The results are encouraging and warrant further structured studies to objectively assess the efficacy of different modalities of Ayurvedic treatment in degenerative ataxias where till date contemporary medicines do not have much to offer.