What is the treatment for astasia and abasia?

Treatment of Astasia-Abasia

Astasia-abasia is primarily a psychogenic (conversion) disorder requiring psychiatric intervention with cognitive behavioral therapy and physical rehabilitation, though organic causes—particularly cerebellar, spinal cord, or basal ganglia pathology—must be excluded first through neuroimaging. 1, 2

Initial Diagnostic Approach

Rule Out Organic Causes First

• Obtain brain MRI without and with contrast to exclude cerebellar lesions, brainstem pathology, multiple sclerosis, or other structural abnormalities that can cause gait dysfunction 3
• Obtain MRI of the cervical and thoracic spine if proprioceptive deficits or spinal cord signs are present, as cord pathology can mimic astasia-abasia 3, 4
• Look for "red flags" including: focal neurological deficits, cranial nerve abnormalities, sensory loss, hyperreflexia, or extracerebellar signs that suggest organic disease 3, 1

Key Clinical Distinctions

• Psychogenic astasia-abasia presents with dramatic inability to stand or walk despite normal motor strength, reflexes, and coordination when tested in bed 1, 5
• Patients often demonstrate bizarre, inconsistent gait patterns with excessive swaying but paradoxically avoid falling 5
• Organic causes (cerebellar lesions, proprioceptive ataxia) show consistent neurological findings: positive Romberg test for sensory ataxia, nystagmus and dysmetria for cerebellar disease 4, 6

Treatment Algorithm

For Psychogenic Astasia-Abasia (After Excluding Organic Disease)

Primary treatment is psychiatric intervention combined with physical therapy 2, 7:

• Initiate cognitive behavioral therapy (CBT) immediately as the cornerstone of treatment for conversion disorder 2, 7
• Address psychosocial stressors that triggered the symptoms—family dysfunction, trauma, or recent life events are common precipitants 2, 7
• Begin intensive physical therapy with gradual mobilization exercises, emphasizing that recovery is expected and achievable 2, 5
• Avoid prolonged bed rest or wheelchair use, which reinforces the sick role and worsens prognosis 5

For Organic Causes

• Cerebellar pathology: Treat the underlying cause (tumor resection, management of multiple sclerosis, stroke rehabilitation). Provide assistive devices and balance training 6
• Proprioceptive ataxia from spinal cord disease: Address the underlying pathology (B12 supplementation for deficiency, immunotherapy for inflammatory myelopathy). Prescribe assistive devices (canes, walkers) and balance training programs 3, 4
• Sjögren's syndrome with CNS involvement: Initiate hydroxychloroquine and corticosteroids, as this combination improved astasia-abasia in documented cases 8

Critical Pitfalls to Avoid

• Do not assume psychogenic etiology without comprehensive neuroimaging—organic causes like cerebellar lesions, spinal cord pathology, or Sjögren's syndrome can present similarly 1, 8
• Do not delay psychiatric referral once organic causes are excluded, as early intervention improves prognosis significantly 2, 7, 5
• Do not overlook pediatric presentations—astasia-abasia can occur in children as young as 7 years old, often triggered by family stress or trauma 2, 7
• Recognize that prognosis is generally favorable with appropriate treatment, particularly when psychosocial stressors are addressed 5

Specific Management Considerations

When Psychogenic Features Predominate

• Look for associated conversion symptoms: approximate answers (Ganser syndrome), pseudohallucinations, or clouding of consciousness may accompany astasia-abasia 2
• Involve family therapy when family dysfunction is identified as a contributing factor 2, 7
• Expect gradual improvement with combined psychiatric and physical therapy over weeks to months 2, 5

When Organic Disease is Confirmed

• For cerebellar lesions: Focus on treating the underlying pathology while providing symptomatic support with assistive devices 6
• For spinal cord involvement: MRI spine is essential to identify treatable causes like compression, inflammation, or nutritional deficiencies 3, 4
• For autoimmune causes: Consider immunosuppressive therapy as demonstrated effective in Sjögren's-related cases 8