11/12/2022
Tabes dorsalis, the most common form of late neurosyphilis, begins as a spirochetal(Treponema pallidum) meningitis. After 10–20 years of persistent infection, damage to the dorsal roots is severe and extensive, producing a set of characteristic symptoms and signs. Symptoms are lightning pains, ataxia, and bladder disturbance; signs include Argyll Robertson pupils, areflexia, loss of proprioceptive sense, Charcot joints, and trophic ulcers. Lancinating or lightning pains are brief, sharp, or stabbing in quality and are more apt to occur in the legs than elsewhere. Sensory disturbances such as coldness, numbness, and tingling also occur and are associated with impairment of light touch, pain, and thermal sensation. Episodes of visceral crisis, characterized by the abrupt onset of epigastric pain that spreads around the body or up over the chest, occur in some 20% of patients.
Most of the features of tabes dorsalis can be explained by lesions of the dorsal roots, dorsal root ganglia, and posterior columns.Ataxia is due to the destruction of proprioceptive fibers, insensitivity to pain follows partial loss of small myelinated and unmyelinated fibers, and bladder hypotonia with overflow incontinence, constipation, and impotence is the result of sacral root damage. Pathological studies disclose thinning and grayness of the posterior roots, especially in the lumbosacral region, and the spinal cord shows degeneration of the posterior columns. A mild reduction of neurons in the DRG occurs, and there is little change in the peripheral nerves. Inflammation may occur all along the posterior root.
Physiotherapy management includes Frenkel's exercise, strengthening exercises, balance retraining and use of assistive devices.
Aims of physiotherapy management include:
Improve coordination
Improve muscle strength.
Improve muscle endurance.
Improve balance.
Improve posture.
Retrain normal movement pattern.
Educate the patient about sensory loss and precautions to be taken.
