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Locomotor Ataxia

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LOCOMOTOR ATAXIA (Gr. a, priv., and ra ts, order; synonyms, Tabes dorsalis, posterior spinal sclerosis ), a progressive degeneration of the nervous system, involving the posterior columns of the spinal cord with other structures, and causing muscular incoordination and disorder of gait and station. The essential symptoms of the disease - stamping gait, and swaying with the eyes shut, the occurrence of blindness and of small fixed pupils - were recognized by Romberg (1851), but it was the clinical genius of Duchenne and his masterly description of the symptoms which led to its acceptance as a definite disease (1858), and he named it locomotor ataxia after its most striking symptom. In 1869 Argyll Robertson discovered that the eye-pupil is inactive to light but acts upon accommodation in the great majority of cases. This most important sign is named the "Argyll Robertson pupil." With an ever-increasing knowledge of the widespread character of this disease and its manifold variations in the complex of symptoms, the tendency among neurologists is to revert to the term employed by Romberg - tabes dorsalis. " Locomotor ataxia," although it expresses a very characteristic feature of the disease, has this objection; it is a symptom which does not occur in the first (preataxic) stage of the disease; indeed a great number of years may elapse before ataxy comes on, and sometimes the patient, after suffering a very long time from the disease, may die from some intercurrent complication, having never been ataxic.

It is generally recognized by neurologists that persons who are not the subjects of acquired or hereditary syphilis do not suffer from this disease; and the average time of onset after infection is ten years (see Neuropathology). There are three stages; (I) The preataxic, (2) the ataxic, (3) the bed-ridden paralytic. The duration of the first stage may be from one or two years, up to twenty years or even longer. In this stage various symptoms may arise. The patient usually complains of shooting, lightninglike pains in the legs, which he may attribute to rheumatism. If a physician examines him he will almost certainly find the knee-jerks absent and Argyll Robertson pupils present; probably on inquiry he will ascertain that the patient has had some difficulty in starting urination, or that he is unable to retain his water or to empty his bladder completely. In other cases, temporary or permanent paralysis of one or more muscles of the eyeball (which causes squint and double vision), a failure of sight ending in blindness, attacks of vomiting (or gastric crises), painless spontaneous fractures of bones and dislocations of joints, failing sexual power and impotence, may lead the patient to consult a physician, when this disease will be diagnosed, although the patient may not as yet have had locomotor ataxy. All cases, however, if they live long enough, pass into the second ataxic stage. The sufferer complains now of difficulty of walking in the dark; he sways with his eyes shut and feels as if he would fall (Romberg's symptom); he has the sensation of walking on wool, numbness and formication of the skin, and many sensory disturbances in the form of partial or complete loss of sensibility to pain, touch and temperature. These disturbances affect especially the feet and legs, and around the trunk at the level of the fourth to the seventh ribs, giving rise to a "girdle sensation." There may be a numbed feeling on the inner side of the arm, and muscular incoordination may affect the upper limb as well as the lower, although there is no wasting or any electrical change. The ataxic gait is very characteristic, owing to the loss of reflex tonus in the muscles, and the absence of guiding sensations from all the deep structures of the limbs, muscles, joints, bones, tendons and ligaments, as well as from the skin of the soles of the feet; therefore the sufferer has to be guided by vision as to where and how to place his feet. This necessitates the bending forward of the body, extension of the knees and broadening of the basis of support; he generally uses a walking stick or even two, and he jerks the leg forward as if he were on wires, bringing the sole of the foot down on the ground with a wide stamping action. If the arm be affected, he is unable to touch the tip of his nose with the eyes shut. Sooner or later he passes into the third bed-ridden stage, with muscles wasted and their tonus so much lost that he is in a perfectly helpless condition.

The complications which may arise in this disease are intercurrent affections due to septic conditions of the bladder, bedsores, pneumonia, vascular and heart affections. About ro% of the cases, at least, develop general paralysis of the insane. This is not surprising seeing that it is due to the same cause, and the etiology of the two diseases is such as to lead many neurologists to consider them one and the same disease affecting different parts of the nervous system. Tabes dorsalis occurs with much greater frequency in men than in women (see Neuropathology).

The avoidance of all stress of the nervous system, whether physical, emotional or intellectual, is indicated, and a simple regular life, without stimulants or indulgence of the sexual passion, is the best means of delaying the progress of the disease. Great attention should be paid to micturition, so as to avoid retention and infection of the bladder. Drugs, even antisyphilitic remedies, appear to have but little influence upon the course of the disease.