Efficacy of Shirodhara and Nasya karma in the management of post-stroke dystonia

Dystonia is the second most common movement disorder after stroke. Occurrences of involuntary movements have been reported in 1%–4% of patients with ischemic and hemorrhagic strokes affecting the basal ganglia, thalamus, and/or their connections. The time course for the development of movement disorders varies considerably from the day of the onset of stroke to several years later and it also depends on the type of movement disorder. At the moment, for many of these disorders, the knowledge of pharmacological treatment is still inadequate. Deep brain stimulation is the surgical treatment option for dystonia; however, its therapeutic mechanism is poorly understood. A 50-year-old male patient with complaints of uncontrolled involuntary movements of the right upper limb associated with pain and fatigue for more than a month, with a history of cerebrovascular accident three months back, was admitted at Government Ayurvedic Hospital. The case was diagnosed as dystonia and correlated with Akshepaka (~clonic convulsions) explained in Ayurveda . This case of poststroke dystonia is managed with Shirodhara (~therapeutic oil-streaming over the head) and Nasya (~medication through nasal route) for a period of 21 days. The patient was assessed based on the Fahn–Marsden Rating Scale, with a score of “12” before and “0” after the management. The patient got complete relief within a span of 21 days, which is worth reporting. This case study demonstrates that dystonia (~ Akshepaka ) in acute phase can be managed by Ayurvedic Panchakarma (~five internal bio-cleansing therapies) procedures. This protocol may be utilized in various other movement disorders with an extended period for efficient results.