Tabes Dorsalis

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Original Editor - Innocent Abugu
Top Contributors - Innocent Abugu, Kim Jackson, Kirenga Bamurange Liliane and Oyemi Sillo

Introduction

Tabes dorsalis is a slowly progressive degenarative disorder of the dorsal column and dorsal root of the spinal cord. Tabes dorsalis is caused by demyelination as a result of an untreated syphilis infection caused by Treponema pallidum. Treponema pallidum infection, if left untreated or partially treated, can lead to late neurosyphilis which has two forms, general paresis (also known as "syphilitic dementia," "dementia paralytica" or "paretic neurosyphilis") and tabes dorsalis (also known as "locomotor ataxia"). It is more common in males than in females.

Clinically Relevant Anatomy

Sensory information is transmitted through the dorsal (posterior) column of the spinal cord and through the medial lemniscus in the brainstem. The dorsal column-medial lemniscal pathway is responsible for conveying sensations of vibration, proprioception and fine touch (tactile sensation).

Pathological Process

Treponemes are spirochetes, which are thin, delicate, helically coiled organisms measuring 5-20 µm in length.Treponema pallidum can be transferred vertically from mother to fetus and through sexual intercourse.

The disease usually involves three phases. The primary infection follows the inoculation of an individual with about 500–1000 bacteria. Within 36 h these replicate and result in a painless ulceration called a chancre. These typically occur in the genital areas. After 2–6 weeks the second stage of the disease continues, with wide infiltration throughout the body and nervous system. Afterward, during the latent stage of disease, patients are frequently asymptomatic for many years. About 10% of patients with untreated syphilis develop neurological symptoms called neurosphyilis, or tabes dorsalis, 10–15 years later.

Clinical Presentation

The neurologic presentation is one of ongoing loss of pain sensation, loss of peripheral reflexes, impairment of vibration and position senses, and progressive ataxia. The earliest stages of neurosyphilis involve inflammation of the meninges presenting with headache, nausea, vomiting, and, occasionally, seizures. There may be chronic destructive changes in the large joints of the affected limbs in far-advanced cases (i.e., Charcot's joints). Incontinence of the bladder and impotence are common. Sudden and severely painful crises of uncertain origin are a characteristic part of the syndrome.

Diagnostic Procedures

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Outcome Measures

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Management / Interventions

Medical treatment

Medical treatment involves penicillin, administered intravenously. Opiates, valproate and carbamazepine are some of the analgesics used in treating pain associated with Tabes dorsalis.

Physiotherapy management

Physiotherapy management includes Frenkel's exercise, strengthening exercises, balance retraining and use of assistive devices. Aims of physiotherapy management include:

• Improve coordination
• Improve muscle strength.
• Improve muscle endurance.
• Improve balance.
• Improve posture.
• Retrain normal movement pattern.
• Educate the patient about sensory loss and precautions to be taken.

Preventive management

Preventive drug therapy should be given to those who have sexual contact with an individual with syphilis.

Differential Diagnosis

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Prognosis

Prognosis is good after treatment, but Tabes dorsalis may lead to paralysis, blindness and dementia if left untreated.

Resources

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