Patient Baseline
Patient ID: SCA2-M48-2025JPR (male, 48 years)
Diagnosis: Spinocerebellar Ataxia type 2 (genetically confirmed ATXN2 CAG expansion); 3.5 years since symptom onset.
Primary Complaints: Unsteady gait with wide base, limb incoordination (finger–nose dysmetria), slurred speech (dysarthria), easy fatigability, 2–3 near-falls/week, poor sleep.
Neurology Work-up: MRI—cerebellar atrophy; NCS—mild length-dependent axonal neuropathy; no dysphagia on bedside screening.
Panchakarma Protocols
- Rukshana And Shodhana (Week-1): Preparatory & Āma-lightening Rūkṣa Svedana (localized dry heat/steam to limbs & paraspinals) on alternate days to soften stiffness without over-fatiguing. Laghutrayī-guided diet reset: warm, easy-to-digest meals; circadian eating; caffeine cut-down; individualized salt moderation to avoid transient ataxia worsening. Gentle prāṇāyāma (nāsāgra-dṛṣṭi, anuloma) and vestibular-safe gaze drills (slow saccade training coordinated with physio).
- Brimhana (Week-2): Core inpatient cycle (14 days) + supervised OPD Abhyanga (full-body oiling with snigdha, vāta-śāmaka taila profile) + Sādhāraṇa/Nādi Svedana daily—dose titrated to avoid exhaustion. Mūrdhni Taila (śiro-pichu 30–35 min/day) for prāṇa-śamana and sleep. Nasya (mṛdu, snigdha—low volume, alternate days x6 sittings) to support ūrdhvajatru. Kṣīra-Basti protocol (brimhana focus): 8-day kala in first cycle—mātrā basti on interposed days for continuity. Śaṣṭika-Śāli Pinda-Sveda (localized to limbs/paraspinals) on alternate days to improve muscle tone and proprioception.
- Rasyana (3rd Week) Cyclic Basti maintenance: 5-day mātrā basti every 3–4 weeks (OPD). Dietary Rasāyana: warm, madhura-pradhāna, snigdha-brimhana meals with adequate high-quality protein, circadian alignment (dinacaryā) and sleep anchoring (niśā-svapna-rakṣaṇa). Manas-care: short daily japa/prārthanā, 10–15 min sunlight AM, screen-time hygiene evening. Rehab integration: Task-oriented gait, balance (BOS narrowing drills), metronome-paced stepping, dysmetria reduction exercises; speech pacing and breath-support drills.
Improvements Observed
- Gait And Balance: Patient was able to walk with support for 10-15 steps by 1st week. 2nd Week- 250 meters walking. On the day of discharge from hospital: patient was able to walk for 500 meters without any support
- Coordination Finger–nose dysmetria decreased; smoother terminal accuracy on the right by thrid week; left improved slower but steady.
- Speech- Dysarthria: clearer consonants in short sentences; reading aloud 1-minute passage with fewer breath-cuts
- Fatigue: mid-day crashes reduced; able to sustain light desk work.
- Sleep & Mood Sleep onset reduced from ~60 min to 20–25 min; fewer night awakenings. Anxiety around falls decreased; patient reported “more trust in legs.”
- Safety No orthostatic episodes. No skin maceration, no nasal irritation. One transient DOMS-like soreness post sveda early in program—resolved with dose adjustment.
Treatment Outcome
After a 24-week integrative Pañcakarma + Rasāyana + Neuro-rehab plan (with maintenance to week 36):
SARA: 18 → 12 (↓6 points; clinically meaningful)
BBS: 34 → 44 (+10; fall risk reduced)
TUG: 19.2 s → 13.1 s (faster sit-stand-walk)
10MWT: 0.92 m/s → 1.21 m/s (more confident gait)
Speech (global 1–5): 3 → 2 (clearer articulation in short phrases)
Fatigue: 6/10 → 3/10
Falls/near-falls: from 2–3/week → <1/week
Sleep: sleep onset latency reduced; nocturnal awakenings ↓
Patient resumed independent flat-surface ambulation without cane for ≤600 m, negotiated stairs with one handrail, and restarted desk work (3–4 hrs/day). No adverse events.