What is ataxia?

Causes and Symptoms

Ataxia most often results from disorders of the cerebellum (a
large structure at the lower back of the brain, just above where the spinal cord
enters the skull at the bottom) or its connections. Disorders resembling ataxia
can also be seen following parietal or frontal lobe lesions of the brain. Ataxia
is a symptom, not a diagnosis. The symptoms of ataxia may affect any part of the
body.

Some medical conditions can cause ataxia to appear suddenly, such as
head
trauma, stroke, brain hemorrhage, brain tumor,
congenital abnormality, postviral infections, exposure to certain drugs or toxins
(for example, alcohol or seizure medications), and cardiac or respiratory arrest.
Other conditions may cause ataxia to appear gradually, such as hypothyroidism,
some vitamin deficiencies (vitamins E or B1), exposure to certain drugs
or toxins (heavy metals, chronic alcohol use, and some cancer drugs), certain
kinds of cancer (ovarian and lung cancer), congenital abnormality, heredity
disorders such as ataxia-telangiectasia and Friedreich
ataxia, neurodegenerative disorders and cerebellar atrophies,
multiple
sclerosis, celiac disease, and human immunodeficiency virus
(HIV) infection.

Treatment and Therapy

A careful neurologic and general physical examination, including blood tests and
brain magnetic resonance imaging (MRI), can determine whether other parts of the
nervous system are impaired and whether a medical illness may be causing ataxia.
No medicine specifically treats the symptom of ataxia. If ataxia is the result of
a stroke, a low vitamin level, or exposure to a toxic drug or chemical, then
treatment involves minimizing the effects of the current stroke and preventing
further ones, instituting vitamin therapy, or avoiding the toxic drug or chemical,
respectively. In some cases, the metabolic disorders that cause ataxia
may be treated with controlled diet and medication. If ataxia is the result of a
tumor, then surgery may be necessary. Many people with hereditary or idiopathic
forms of ataxia have additional symptoms. Genetic testing may be required to
detect hereditary spinocerebellar ataxia-6, Friedreich ataxia, or fragile X
tremor/ataxia syndrome (FXTAS). Medications or other therapies might be
appropriate for some of these symptoms, such as tremor, stiffness, spasticity,
depression, and sleep disorders.

The mainstay of treatment for ataxia is the provision of physical and
occupational
therapy directed at maintaining function for as long as
possible. Gait training and assistive devices such as canes, crutches, or a walker
are useful to prevent falls and enhance mobility. Other adapted utensils and tools
may be helpful to assist with writing, feeding, and self-care if hand or arm
coordination is impaired, as may be speech therapy and communication devices for
those with impaired speech.

Extremity ataxia that interferes with activities of daily living, such as feeding
or dressing, may be treated with proximal splinting. Distal weights may dampen
intention tremor. If the ataxia is exacerbated by weakness, strengthening
exercises can be beneficial. Specific coordinated exercises are often helpful in
treating static causes of ataxia (stroke or head injury) but not as useful in
treating progressive disorders such as hereditary ataxias. Ataxia of eye movements
rarely requires treatment, but it may be disabling if the patient has difficulty
reading.

Bibliography:

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Ellison, David, and Seth Love, eds.
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Gillen, G. “Improving
Activities of Daily Living Performance in an Adult with Ataxia.”
American Journal of Occupational Therapy 54.1 (2000):
89–96. Print.

Gillen, G. “Improving
Mobility and Community Access in an Adult with Ataxia.” American
Journal of Occupational Therapy 56.4 (2002): 462–66.
Print.

Hong, Sung Hoi, ed. Ataxia:
Causes, Symptoms and Treatment. New York: Nova, 2012.
Print.

Larner, Andrew J., et al. A–Z of
Neurological Practice: A Clinical Guide to Neurology. 2nd ed.
Dordrecht: Springer, 2011. Print.

Manto, Mario Ubaldo. Cerebellar
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Cambridge: Cambridge UP, 2010. Print.