Tabes dorsalis child through the placenta, while the
baby is still in the womb.
Tabes Dorsalis also called Progressive
Locomotor Ataxia, rare neurologic form
of tertiary syphilis, is a slowly
progressive, degenerative disease that
involves the posterior columns and
posterior roots of the spinal cord and
results in progressive loss of peripheral
reflexes, impairment of vibration and
position sense, and progressive ataxia.
It is also called spinal syphilis / syphilitic
myelopathy/ / Duchenne's Disease /
Locomotor Ataxia / Myelosyphilis
Causes
Syphilis is a sexually transmitted
disease caused by a contagious
bacterial infection named Treponema
pallidum. During initial infection, the
bacteria spread through the blood
stream into remote sites like the brain
and spinal cord, but remain silent in
these areas. If proper treatment is not
instituted, neurological disorders arise
about a decade later and is called
neurosyphilis. Damage to the spinal
cord substance due to syphilis is called
tabes dorsalis.
Course of the disease
Syphilis is a very common infectious
disease caused by the bacterium
Treponema pallidum. Syphilis is
generally transmitted through sexual
contact. A pregnant woman affected by
Syphilis can transmit the infection to her
There are 3 stages in the progression of
Syphilis; Primary, Secondary, and
Tertiary. The sooner the treatment is
started, better is the outcome. If
treatment is delayed or is lacking; it
could develop into a serious medical
issue with long-term neurological
complications
Primary stage: After the initial infection
(direct sexual contact with affected
individual), the bacterium spreads all
over the body using the blood vessels
and lymphatic system, and multiply
rapidly. Within 36 h these replicate and
result in a painless ulceration called a
chancre. If untreated, the chancre will
heal within 3 to 6 weeks, after which
most patients progress to the secondary
stage.
Secondary stage: The bacterium
invades tissues, cerebrospinal fluid,
skin, and mucus membranes. It causes
inflammatory rashes on the body
(secondary lesions). This continues till a
stage of dormancy is reached; after
which multiple relapse or remissions
take place. Approximately one third of
patients with untreated latent syphilis
develop tertiary manifestations of the
disease after a variable period ranging
from months to years.
Tertiary stage: Tertiary Syphilis is
classified into three key types,
principally based on the infestation
location. These are: Neurosyphilis,
Cardiovascular Syphilis, and
Gummatous Syphilis. Neurosyphilis
occurs when the infection affects the
central nervous system. It is grouped
into six principal types; – Tabes Dorsalis
is one among them.
Pathology
In tabes dorsalis, the preganglionic
portion of the dorsal roots is infiltrated
with lymphocytes and plasma cells, and
the posterior columns of the spinal cord
become atrophic. Inflammation occurs in
the dorsal columns of the spinal cord.
These columns are in the portion of the
spinal cord closest to the back and have
nerve fibers that carry sensory
information like deep pain and position
sense (proprioception) The progressive
degeneration of the spinal sensory
nerve roots along the dorsal column of
the spinal cord essentially causes a
functional deafferentation. Such
deafferentation typically causes hyper
excitability in the ascending pain
pathways and is irreversible.
Signs and symptoms :
 Intense back and leg pain
(stabbing pain that comes in
flashes and disappears)
 Problems with gait, walking,
unsteady gait called "sensory
ataxia". stooped forward with a
wide based "high-stepping" gait
and eyes glued to the ground in
order to prevent falling
 loss of tendon reflexes
 bone joint degeneration
 Loss of positional sense (termed
as proprioception) - positive
Romberg,s sign.
 Abnormal increase in touch, feel
sensitivity "stabbing" or
"lightning-like"
 traumatic ulcers or sores on the
lower extremities and feet
 Lack of proper muscle movement
coordination (ataxia)
 Blindness, disorder of the eye
pupils - pupils are
characteristically small and non-
reactive to light and called
"Argyll-Robertson" pupils
 sensory deficits cause loss of
bladder and sometimes bowel
control
 sexual function impairment
 Mental health disorders: Loss of
memory, dementia
 Vomiting and nausea, intense
abdominal pain
Diagnosis
Diagnosis of Syphilis may be made at
any stage of the disease. A few
diagnostic tests performed for Syphilis
include the following:
 Physical exam with evaluation of
medical history
 Exam of cerebrospinal fluid, via a
lumbar puncture
 CT scan of cranium
 Cerebral angiogram
 MRI scan of brain, spinal cord
 Blood test, for detecting
antibodies against Syphilis Two
 serological tests are available Physiotherapy
(Rapid Plasma Reagin and
Venereal Disease Research Goals for Physiotherapy:
Laboratory) that can detect
established infection with high 1. Educate about sensory loss and
accuracy. educate on precautions to be taken
2. Strengthening of muscles
Treatment 3. Improve balance
4. Improve mobility
Treatment is aimed at curing the 5. Improve coordination
infection and hopefully halting the
progression of neurologic damage. Physiotherapy Management:
Treatment is unfortunately limited in
reversing the damage already done and 1. Strengthening of muscles.
the degree of recovery depends on the 2. Use of assistive aids to improve
extent of damage when therapy is mobility
started. 3. Balance retraining
Since 1945, syphilis has been effectively 4. Frenkel’s Exercise.
treated with penicillin, and the bacterium
has not developed any resistance over
the past 70 years. High doses are
necessary to reach the CNS, including
large doses of intravenous penicillin G
daily over 10–14 days.

Recovery and rehabilitation

Assistance or supervision may be

needed for self-care activities like
eating, showering, dressing etc. Patients
may require assistive devices like a
cane, walker or a wheelchair to
overcome gait difficulty. Diapers or
urinary catheters are used for urinary
incontinence. Surgery can help replace
joints destroyed by arthritis. Patients
need a good bowel regimen to avoid
constipation.