Unusual association of sporadic olivopontocerebellar atrophy and motor neuron disease

[Amyotrophic lateral sclerosis with muscle weakness and dropped head during the course of Parkinson's disease: an autopsy case]

A 64-year-old female developed Parkinson's disease at the age of 52 years. She experienced muscle weakness in the upper right extremities and dropped head at 62 and 63 years, respectively; both symptoms were considered to be associated with Parkinson's disease (PD). The dosage of L-DOPA was increased from 200 mg/day to 900 mg/day; however, her neurological symptoms did not improve. Eventually, she was diagnosed with amyotrophic lateral sclerosis (ALS) at 64 years. She was placed under palliative care, and died of respiratory failure and malnutrition. Neuropathologic findings were consistent with the coexistence of PD and ALS. In fact, there were α-synuclein immunoreactive Lewy bodies (Braak stage 4) as well as TDP-43 immunoreactive deposits in the motor nuclei at the level of brainstem and spinal cord. Therefore, coexisting pathologies must be taken into account in a patient showing multi-system symptoms.

Challenge-oriented gait and balance training in sporadic olivopontocerebellar atrophy: a case study

BACKGROUND AND PURPOSE

Sporadic olivopontocerebellar atrophy (OPCA) is a rare and debilitating neurologic disease of insidious onset. It is characterized by atrophy of the cerebellum, pons, and inferior olivary nuclei with concomitant ambulation deficits and dyscoordination. To our knowledge, there has been no published study investigating any aspect of rehabilitation in OPCA. Therefore, the purpose of this study was to investigate the use of challenge-oriented gait and balance training to improve gait and balance in OPCA.

CASE DESCRIPTION

An otherwise healthy 19-year-old woman with moderate to severe upper and lower extremity ataxia, secondary to sporadic OPCA, participated in this prospective case study. She also had a vestibulotoxic treatment procedure to decrease the severity of her vertigo.

INTERVENTION

This individual participated in a 12-week gait and balance training program (five times per week), which consisted of one to two hours of various challenging static and dynamic balance tasks. To measure her progress, the following scales and tests were used: Berg Balance Scale, Dynamic Gait Index, Activities-Specific Balance Confidence Scale, computerized dynamic posturography (sensory organization test and limits of stability), and self-selected gait velocity.

OUTCOMES

: Improvements were noted in all the dependent measures (pre to post): Berg Balance Scale (34/56 to 39/56), Dynamic Gait Index (1/24 to 7/24), Activities-Specific Balance Confidence Scale (50.6%-85.1%), sensory organization test (composite score, 31/100 to 47/100), limits of stability (maximum excursion, 89-105; endpoint excursion, 57-93; directional control, 60-78), and SSGV (0.375-0.526 m/sec).

DISCUSSION

Results from this case study suggest that a gait and balance training program may be beneficial to individuals with ataxia from OPCA. This early evidence warrants further investigation using more rigorous methods.