Case Quizes

Case of ‘Spino Cerebellar Ataxia’

This is a case of Spino Cerebellar Ataxia handled by the renowned Dr. Amarsinha Nikam. Can you solve this case? Send the rubrics you chose and the remedy to [email protected]

Editor’s note:This is a case of Spino Cerebellar Ataxia handled by the renowned Dr. Amarsinha Nikam. Can you solve this case? Send the rubrics you chose and the remedy to : [email protected]


This is a very interesting case of a patient aged 37 who had come to me from Australia. He was diagnosed to have a rare genetic disorder “Spino Cerebellar Ataxia”. He was a known Diabetic since 2001 and was on insulin for two years. He was also shown to have Osteoporosis.

His symptomatic history is as follows:

Initially his family members and friends noticed his imbalance while walking. As the days progressed, the imbalance increased and he started walking like a drunkard, in a zigzag manner. He couldn’t close his eyes even for 30 seconds while standing, as he would fall down. This made it difficult for him to do his day to day activities, like bathing. While bathing it was a must for him to keep his hand on his forehead to prevent the water coming to his eyes, since he may fall. His speech was not clear. He had slurred speech.

He had consulted Neurologists in Australia who suggested MRI of the brain and few blood tests which proved to be normal. At last his genetic assessment showed Spino Cerebellar Ataxia disorder. He consulted various experts in this field and they informed him it was a rare and dangerous disorder which gradually makes the person bedridden. He was also told that the allopathic system had no treatment for it, and that he had to suffer consequences till the end of his life.

Later he was referred to me by one of his friends who resided in Bangalore.

Spinocerebellar ataxia :
Signs and symptoms

Spinocerebellar ataxia (SCA) is a group of genetic disorders characterized by slowly progressive incoordination of gait and is often associated with poor coordination of hands, speech, and eye movements. Frequently, atrophy of the cerebellum occurs, and different ataxias are known to affect different regions within the cerebellum.[14] As with other forms of ataxia, SCA results in unsteady and clumsy motion of the body due to a failure of the fine coordination of muscle movements, along with other symptoms.

The symptoms of an ataxia vary with the specific type and with the individual patient. Generally, a person with ataxia retains full mental capacity but may progressively lose physical control.


The hereditary ataxias are categorized by mode of inheritance and causative gene or chromosomal locus. The hereditary ataxias can be inherited in an autosomal dominant, autosomal recessive, or X-linked manner.

  • Many types of autosomal dominant cerebellar ataxias are now known for which specific genetic information is available. Synonyms for autosomal dominant cerebellar ataxias (ADCA) used prior to the current understanding of the molecular genetics were Marie’s ataxia, inherited olivopontocerebellar atrophy, cerebello-olivary atrophy, or the more generic term “spinocerebellar degeneration.” (Spinocerebellar degeneration is a rare inherited neurological disorder of the central nervous system characterized by the slow degeneration of certain areas of the brain. There are three forms of spinocerebellar degeneration: Types 1, 2, 3. Symptoms begin during adulthood.)

  • There are five typical autosomal recessive disorders in which ataxia is a prominent feature: Friedreich ataxia, ataxia-telangiectasia, ataxia with vitamin E deficiency, ataxia with oculomotor apraxia (AOA), spastic ataxia. Disorder subdivisions: Friedreich’s ataxia, Spinocerebellar ataxia, Ataxia telangiectasia, Vasomotor ataxia, Vestibulocerebellar, Ataxiadynamia, Ataxiophemia, Olivopontocerebellar atrophy, and Charcot-Marie-Tooth disease.


There is no currently known cure for spinocerebellar ataxia, which is considered to be a progressive and irreversible disease, although not all types cause equally severe disability. Treatments are generally directed towards alleviating symptoms, not the disease itself. Many patients with hereditary or idiopathic forms of ataxia have other symptoms in addition to ataxia. Medications or other therapies might be appropriate for some of these symptoms, which could include tremor, stiffness, depression, spasticity, and sleep disorders, among others. Both onset of initial symptoms and duration of disease are variable. Typically, a person afflicted with this disease will eventually be unable to perform daily tasks (ADLs). However, rehabilitation therapists can help patients to maximize their ability of self-care and delay deterioration to certain extent.


What is osteoporosis?

Osteoporosis is a condition characterized by a decrease in the density of bone, decreasing its strength and resulting in fragile bones. Osteoporosis literally leads to abnormally porous bone that is compressible, like a sponge. This disorder of the skeleton weakens the bone and results in frequent fractures (breaks) in the bones. Osteopenia is a condition of bone that is slightly less dense than normal bone, but not to the degree of bones in osteoporosis.

  • Investigations :

16.02.2009 : Molecular Med-lab :

  • Spinocerebellar Ataxia Type I.

Test Request: SCA1 DNA testing.


  • A 2:51 repeats.

  • A 1:31 repeats.

Interpretation :

Normal range: 24-38 repeats.

Affected range: 42-82 repeats.

This result confirms a diagnosis of SCA1 in this patient. Children of the patient have a priority risk of 50% to inherit the disease.

  • C/C :

    1. Abnormal gait – tottering, staggering since 4 yrs.

  • Gradual onset. Rapid progress since 1 yr.

  • Imbalance during walking. He fell down twice.

  • Can’t stand on one leg and also on closing the eyes/

  • < Mental exertion.

  • Cause: Genetic.

2. Slurred speech since 4 yrs.

  • Gradual onset. Rapid progress since 1 yr.

  • < Tension.

    1. Pain in both knee joints since 3 yrs.

    • Gradual onset.

    • Stitching type of pain.

    • He stands for 6 hours daily (for his work).

    • < Early morning. > Hard pressure.

    • < Rest.

  • Past History :

  • Appendectomy 9 yrs before.

  • Jaundice in 1999.

  • Chikenpox in childhood.

  • # of Rt. metatarsal joints in 2008.

  • Family History :

Father : D.M., C.R.F.

Mother : Having same problem. Spino Cerebellar Ataxia.

  • Physical Generals :

    • Habit : Chronic Alcoholic for 17 years. Stopped since 4 years. Chronic Smoker for 17 yrs. 20 Cigarettes /day. Stopped since 4 years.
    • Diet : Veg.

    • Appetite : Good. Can’t tolerate hunger.

    • Desire : Sweets, Fried food, Ghee, Ice Cream, Cold Drinks, Milk.

    • Aversion : Non-veg.

    • Eyes : Wearing spectacles since 2000.
    • Head : Frontal headache occasionally.
    • Thirst : Good. 3-4 Lit./day.

    • Tongue : Dry & pale.

    • Teeth : Caries on Rt. side one tooth. 4 false teeth on lower jaw.

    • Gums : Bleeding gums occasionally. Had done flat surgery for gums.
    • Back : Pain in Lt. scapular region since 1994. Duration 2-3 hrs.
    • Perspiration : Profuse, Hot sweating. Mole on nose & face.

    • Sleep : sleep Unrefreshing. Snores.

Position: Lies on (Lt.) side.

    • Thermals : Towards Chilly

    • Mind:

  1. Tell me about your childhood.

I am brought up in a joint family in a village. I have one brother elder to me and a sister younger to me. I have completed Diploma in Mechanical Engineering.

2. Tell me about your nature.

I was short tempered. Mostly I get angry when I see anything untidy in my house. I was very close with my friends. Friendly nature. I’m very cool and jovial. I like drawing. I love being in parties and enjoying with my friends. I get angry when my house is not clean or if someone is disobeying me. I express it by shouting at them.

I’m very sensitive to insults; if someone does I’ll be waiting for an opportunity to pinch them back. I am fond of company of people, yet I won’t like wasting money unnecessarily on others or helping others.

I love watching movies.

I was an alcoholic and smoker for 17 years. I enjoyed my life to the fullest.

But when my BSL was raised, I was supposed to quit it. Even now, I feel why this happened to me in my young age? Feeling sad about my disease.

I miss the parties and enjoyment with my friends.

His brother, who was accompanying him, added that he is talkative and enjoys company.

  1. Tell me about your worries.

I’m worried about my future and my family. I feel sad when I think about the prognosis of the disease.

I am worried, feeling whether it will make me bedridden like my mother, since I have inherited the disease from her.

Whenever any relative or anyone inquires about my health, I don’t like it. I feel hurt.

I miss the enjoyment with my friends. Sometimes, when I’m alone I weep.

4.  Any fear?

I have great fear of heights.


Solve this case and send the rubrics you chose and the remedy to : [email protected]

About the author

Amarsinha Nikam

Dr. Amarsinha Nikam is a renowned homeopath who runs Aditya Homoeopathic Hospital and Healing Centre in Pune. He started his career as R.M.O. at Lokmanya Hospital Pune, Homoeopathy Division and subsequently practiced as the consultant Homoeopath for 14 years at various places such as Beed, Khopoli, Chakan, Kate – Pimple, Pimple – Gurav and Pimpri Gaon, Pune. Dr. Nikam teaches students to understand the depth of homeopathic treatment and differentiate it from other pathies. He instructs them in his method of practice, but also inspires them to innovate and explore.


  • Medicine is Phosphorus….Rubrics:-1. sadness disease about, 2.anxiety future about, 3. fear height of, desires, 5. friendly,6. sleep position-left side.7. chilly+thirsty..

  • Calc Carb. Chilly, craves cold drinks, milk, likes order in his life, sensitive nature, likes company, osteoporosis

  • dear dr, i think the similimum is ARG-NIT. i took the following rubrics:
    vertigo- standing,while eyes closed
    extrimities-tottering gait
    vertigo-accompnied by staggering
    mind-mental exertion agg.
    mind-speech incoherent
    mind-fear-high places of
    mind-company-desire for
    mind-anxiety-health;about-own health;ones
    generals-food and drinks-ice cream,sweets,butter,cold drink,cold water-desire

    • I see that someone called Vidyasagar has suggested a remedy called Hymosa which I am trying to track down in Q form for a patient with arthritis. Could you kindly ask this person if they can help me? Thanks in advance of your help and Happy New Year!

  • I agree with the other posts rubrics but feel that overall Nux Vomica or possibly Lycopodium are the most likely single remedy for this case especially nature/speech/ataxia/ knees

  • Dear Dr.

    We may start the treatment with Sulf.30 1 doze early morning (empty stomach
    After one week, Argn. Nit. 30
    If there is improvement only little bit we may give the patient Argn.nit. 200 with 1 Tb. of KP+NM+CF+CP after every five minutes on the 2nd day and can see the results after 15 days

  • dear dr,
    we may give one doze of sulf 30 Ist (empty Stomach) for staggering, mental extertion
    After one week We may give Argn.Nit 30(if there is improvement) we may increase the potency in 200 one doze again which is also for
    vertigo- standing,while eyes closed
    extrimities-tottering gait
    vertigo-accompnied by staggering
    mind-mental exertion agg.
    mind-speech incoherent
    mind-fear-high places of
    mind-company-desire for
    mind-anxiety-health;about-own health;ones
    generals-food and drinks-ice cream,sweets,butter,cold drink,cold water-desire

  • This is a very deep pathology, and from the prognosis the level of health is at a very low step of the ladder, so i see many remedies would be needed in time to bring back to a state of health, and perhaps only relief can be achieved rather then total cure, so to find the most upper layer remedy and seeing which symptoms are most important, the thirst i would leave out as most diabetics have that, arg nit came up first in my analysis but i would not go for that, i would start with nuv v, and drop many of the generals as they may belong to the next remedy. What i read about him is not the essence of phos, gels crossed my mind and 2 very rare remedy called HELO and another called ONOS was interesting to read about, (boericke) When i hear about his past life style and and partyies, drinking etc, nuv x could be a good way of opening up the case, and then the next remedy will become more clear in time.

  • Dear dr

    I think Nat mur is an excellent remedy for him because mental symptoms are dominating in this case.
    2.anxiety about future
    5.dominating,fastidious,irritable,friendly,cries alone,doesn’t like sympathy,mental exertion agg,

  • Here are the rubrics I used for my repertorisation of this case:

    1 MIND – AMUSEMENT – desire for
    2 MIND – COMPANY – desire for
    3 MIND – CONSOLATION – agg.
    5 MIND – FEAR – high places, of
    6 MIND – HATRED – revengeful; hatred and
    9 VERTIGO – FALL, tendency to
    10 MOUTH – SPEECH – thick
    11 EXTREMITIES – PAIN – Knees – morning
    12 EXTREMITIES – PAIN – Knees – stitching pain

    The remedies that came up for differentiation were Lachesis, Phosphorus and Belladonna.
    I eliminate Bell because the symptoms have come on gradually and there is no acute intensity to the case.
    It is tempting to prescribe Lachesis because of the morning aggravation; the history of alcoholism; the anger and desire to take revenge on people who insult him.
    In the end I decide to prescribe Phos, because of the patient’s intolerance for hunger; his desire for icecream and cold drinks; his aversion to meat (non-veg); and his sociable nature.
    Thanks for the interesting case.

  • Dear Dr,
    its a good case, here i would like to start with one dose of N.Vom and then see if any other remedy coming up,else try SULFONAL in low potency.

  • Dear DE-r,

    Start the treatment with Argentum Nitricum 1M and repeat it after every two weeks. No other medicine on that day.

    Then continue with Ailanthus 30,three dozes daily

    Hoping for a positive response of the case,

    Dr.Akram Butt

  • In my opinion we may start with a single dose of Alumina 2c to be repeated after 7 days

    Curare can also be of some help

  • rubrics selected : [mind] malicious,spiteful,vindictive
    [perspitation] perspiration,hot
    [generalities] closing eyes,ailments,on
    [mind] alcoholism,dipsomania
    [mind] fastidious
    on cross repertorizaton we are left with – nux-v; puls; sep;con; sulph;phos; thuja
    hot remedies are ruled out , so we have – nux-v;sep; con; phos
    his extrovert + libertinism+ cravings +enjoyful nature suggests – PHOSPHORUS to be the right remedy for this case

  • This is avery deep case and prognosis is rather poor.but looking at his past high living and the symptomology am tempted to start with Nux V 30C X a day fora couple of days then give Argen N because of dominanceof the mental symptons.

  • Dr. Nikam
    Based on totality of the symptoms, esp. the core of his ailment, something apears very specific to me : Quitting alchohol and tobocco for the last 4 yrs- onset of the symptoms- , and he totally feels OBLIGATED to live this life! which he does not like at all!
    I will give him Staphysagria , and some dose of Nux Vomica.

    Thanks for the opportunity!
    Nina Malek

  • what i think is that the remedy which i will give is Agaricus 30
    Syphilitic disease and remedy also must be Syphilitic with its pathology and mental of same level.

  • Dear Dr.
    However the Phosphorus seems to be the best, but looking at the aetiolog , it may refer or lead to Graphities and Nux Moschata in Higher potencies

  • Dear Dr. Amarsinha

    First, I would like to thank you upon the knowledge you offer to all new homeopaths.
    After my search the predominant remedy is Phosphorus.

  • Dear sir,

    According to me this case is suit to Nux vomica 200 at 4.00 pm and Arsenic Album 200 in the morning.

    * Suggestion : To walk in the morning 1/2 hr. before sun rise.
    To avoid wine and smoking.
    To wash eyes with normal water at least five minuts thrise a day.
    To avoid all fast food.

  • Argentum Nitricum 200 once in a week and Biochemic K.P.+C.P.+Sil.+N.P. one tb.each Three times a day. Wait for fifteen days for result.prescription will change according to second case taking.eager to know how he was treated by Dr.Nikam, Thanks .. will wait for next case.

  • sir
    i think medicine is arsenic as pateint is chilly,fastidous especially for cleaniness,he is avraice as spend money less.he is anxious about health and future which also points to it.senstive nature also points to arsenic .syphillitic maism also covered by arsenic. so think about arsenic salts.

  • miasm- syco-syphilis
    degenerative spinal pathology, suggested remedies
    Argentum nit or Alumina 30 repeated frequently with Medorrhinum 1M as intercurrent every 15 days

  • I took following rubrics:
    Mind/fear/ high places
    Mind/exertion/mental agg
    Vertigo/closing eyes on
    Extremities /Ataxia
    Extremities /pain/knee/motion amel
    Extremities/pain/knee/pressure amel

    I used Kent’s repertory and got Arg-n 6/11, Sulph 6/1o, Agar 5/9, Ars 5/7, Calc 5/10, Phos 5/10, Alum 4/11, Caust 4/8 etc.

    Arg-n and Sulph seem not to be suitable as they are “hot” remedies.
    Phos has strong agg when sleeping on the left side.
    Caust, Calc and Agar seem not to cover totality of the case.
    ARSENICUM can be remedy of choise, taking in account desire for company, avariceness, chilliness,

    Phosphor or Arsenicum can be chosen, additional information necessary for differentiation.

    Thank you for posting the case.

  • Lycopodium is most probably his/her medicine. Is fond of company. is a miser. had liver trouble in the past osteoporosis. shoutes at others . Fear of heights, liking for sweets are confusing. Will probably need sulphur and also Tuberculinum to finish the case. May take upwards of three years for cure. All sour articles of food are prohibited/

  • Sir gone thru your article and very much inspired. Informative value make hopes alive. I.had patient of spine celebar Ataxia too. Meet you soon. Regards.

  • Dr. Sab me dognosed Spino Cerebellar Ataxia
    I treated homeo always
    What i do now
    I use Avina stevio
    Norogin -e

  • Sir my brother who is 61 year old is suffering from autosomal-dominant-hereditary-ataxia. he is unable to control limbs movement(both arms and legs) his movements are abrupt not smooth.
    Any treatment to manage this problem. even if progress of disease slows down .

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