Subacute Combined Degenerative Spinal Cord Disorder

Subacute Combined Degenerative Spinal Cord Disorder (SCDSCD) is a rare and progressive neurological condition that primarily affects the spinal cord, leading to a combination of both motor and sensory impairments. The disorder typically manifests in the subacute phase, meaning that its progression is neither immediate nor sudden but occurs over a period of weeks to months. SCDSCD primarily affects the dorsal and lateral columns of the spinal cord, which are responsible for carrying sensory and motor signals from the brain to the rest of the body. It can be debilitating and, if not diagnosed and treated in time, may lead to permanent disability.

This disorder is most commonly linked to vitamin B12 deficiency, although it can also be associated with other causes, such as toxins, metabolic disorders, infections, and autoimmune diseases. Early recognition and treatment are crucial in managing the condition and preventing irreversible damage.

1. Dr Dhara Sharma MPT Neuro S C D C

2. Sub acute combined degeneration of spinal cord, also known as Lichtheim's disease, refers to degeneration of the posterior and lateral columns of the spinal cord Usually, as a result of vitamin B12 deficiency. Often associated with pernicious anaemia.

3. In subacute combined degeneration of spinal cord, the "combined" refers to the fact that the dorsal columns and lateral corticospinal tracts are both affected, in contrast to tabes dorsalis which is selective for the dorsal columns

4. This disorder affects about 1 of 10,000 people, usually those older than 40. It is due to a deficiency of vitamin B12, which usually also causes pernicious anemia . Usually, the deficiency is not related to diet but to the body's inability to absorb vitamin B12

5. Vitamin B12 is necessary for the formation and maintenance of a myelin sheath that surrounds some nerve cells and that speeds transmission of nerve signals. In subacute combined degeneration, the sheath is damaged, causing sensory and motor nerve fibers from the spinal cord to degenerate. The brain, nerves of the eyes, and peripheral nerves are sometimes also damaged

6. Investigations

7. MRI

8. Clinical features

9. Assessment

10. Abnormal findings Muscle weakness Sensation disturbances on both sides of the body, especially in the legs and arms. Reflexes are often abnormal. Muscles may develop spasticity. Reduced sense of touch, pain, and temperature. Mental changes range from mild forgetfulness to severe dementia or psychosis. Severe dementia is uncommon, but in some cases, it is the first symptom of the disorder.

11. An eye examination may show damage to the optic nerve, a condition called optic neuritis. Signs of nerve inflammation may be seen during a retinal exam. There may also be abnormal pupil responses, decreased visual acuity, and other changes. Blood tests, including a complete blood count (CBC), are used to diagnose anemia or a B12 deficiency.

12. Treatment

13. Treatment Early treatment improves the chances of a good outcome, so the disease should be treated promptly. Vitamin B12 is given, usually by injection into a muscle. Injections are often given once a day for a week, then weekly for about 1 month, and then monthly. Vitamin B12 injections must continue throughout life to prevent symptoms from returning.

14. Prognosis How well a person does depends on how long they had symptoms before receiving treatment. If treatment was received within a few weeks, complete recovery usually occurs. If treatment was delayed for longer than 1 or 2 months, recovery isn't as complete. If you had symptoms for many months without receiving medical care, treatment may slow or stop your symptoms, but it is unlikely that you will recover function that you have already lost. Untreated, the disorder results in progressive and irreversible damage to the nervous system

15. Physiotherapy management

16. Goals Education to the patient and family Strength gain Decrease the pain Normalization of tone Gait Develop movement control Sympathetic approach

17. Interventions Strengthening exercises Frenkle's exercises Stretching Balance rehabilitation Gait rehabilitation Use of auditory stimuli than visual Make the patient independet