Description, Causes and Risk Factors:
Astasia-abasia refers to the inability to stand or walk despite possessing good motor strength and conserved voluntary coordination. Patients are unable to maintain standing posture unassisted and exhibit unusual and dramatic wild lurches in various directions. Although it is usually regarded as a psychogenic disorder, organic causes have been reported. We describe herein a patient who presented with alcohol-induced episodic astasia-abasia associated with hyperperfusion in the subthalamic region and dorsal brainstem.
Many times disorders like astasia-abasia are thought to be a result of some form of severe stress and are psychological in nature. Also known as conversion ataxia, this disorder may develop from some form of injury, abuse or other physical harm. This may result in the development of phobias which may also cause the condition. Examples of related phobias include a fear of walking and standing called stasiphobia, and basophobia or basiphobia, which is a phobia that occurs when a person is unable to stand for fear of walking and falling.
Symptomatic astasia-abasia has been associated with lesions affecting the pontomesencephalic region, thalamus, corpus callosum, or cingulated cortex. Although not referred to as astasia-abasia, postural and gait disturbance without limb ataxia has also been reported in patients with dorsal midbrain infarctions. It has been postulated that astasia-abasia results from disruption of the vestibulocerebellothalamocortical connection or from damage to the mesencephalic locomotor region (MLR). The dorsal brainstem, and speci?cally the midbrain tegmentum, is the anatomical region where these two functional systems overlap.
Despite not causing any physical harm, astasia-abasia can have a negative impact on the lives of the people who are suffering from it. If left without treatment, it can have a negative effect on personal relationships and in the sufferer's ability to work.
Those with astasia-abasia display certain characteristic mannerisms when trying to walk or stand. Swaying of the torso and an off-balance appearance occurs when attempting to stand, while walking results in a lurching, stumbling and uncoordinated gait. These types of gait symptoms are common to conversion disorders and are frequently viewed as potential medical signs that assist in making the diagnosis. Despite this apparent difficulty with motor function and coordination however, those with astasia-abasia have normal leg movement when sitting or reclining.
There are no proper diagnostic techniques to detect this unusual movement disorder. The various symptoms, that this disorder is commonly characterized by, are frequently viewed as potential signs that may assist in diagnosis. Exclusion of severe cases of neurological disorders, that typically resemble this condition, may aid in arriving at the right conclusion.
The most effective treatment of astasia-abasia seems to be a removal of stress inducing stimuli and allowing the patient to rest and regain strength. Despite the lack of a direct prescribable cure for the effect of astasia-abasia on the motor system of the legs, in almost all documented cases physical rehabilitation and relief from mental stressors have led to a full recovery. Although astasia-abasia is not expressly associated with any neurological disorders, there is a strong correlation between general mental hysteria and the symptoms of astasia-abasia. Therefore, isolation of the patient from the situation causing them hysteria is the most efficient way to rid them of disabling motor symptoms. Another method for treatment that patients who experience astasia-abasia is to have therapy for the triceps surae muscle. This therapy can help strengthen these muscles to help maintain an upright posture. It has also been suggested that ankle-foot orthoses be prescribed for these patients. This would help patients with astasia-abasia maintain balance by preventing ankle dorsiflexion.
Currently, physical therapy and rehabilitation are widely accepted as the best treatments for the symptoms of astasia-abasia. There is, however, evidence to suggest that regulation of a patient's social situation and behavioral influences can influence the effectiveness of rehabilitation.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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