Ataxia

Ataxia refers to a group of neurological disorders characterized by uncoordinated voluntary movements like

• speech,
• walking,
• swallowing.

Ataxia is often a sign of an underlying medical condition. Ataxia may be caused by many conditions like

• cerebellar damage,
• stroke,
• tumor,
• multiple sclerosis.

Ataxia is diagnosed on the basis of review of symptoms and family history, and neurological evaluation. Symptoms of ataxia varies with the type.

There are three broad categories of ataxia

• acquired,
• hereditary,
• idiopathic late-onset cerebellar ataxia (ILOCA).

Treatment depends on the cause of ataxia. Supportive devices are suggested to improve the symptoms of the condition and also the quality of life of the person.

Other treatment methods include

• physical therapy,
• occupational therapy,
• speech therapy. 

Symptoms vary with the type and severity of Ataxia.

Symptoms of ataxia caused by an underlying condition may appear at any age. The initial symptoms of ataxia include poor coordination of limbs and slurred speech.

Patients often find it difficult to control volume and pitch of the sound.

Advanced symptoms of ataxia include

• Difficulty in swallowing
• Vague facial expressions
• Tremors
• Rapid, repetitious movement of eye
• High arch of foot
• Cold feet
• Difficulty in balancing
• Vision and hearing problems
• Depression

In cerebellar ataxia, small veins may appear around the eyes and ears.

Friedreich's ataxia is characterized by curvature of the spine and cardiomyopathy.

Damage or degeneration of the nerve cells in the cerebellum causes ataxia.

Some of the causes of ataxia are given below.

• Damage of brain or spinal cord due to trauma, as in an accident, leads to sudden onset of ataxia. This condition is known as acute cerebellar ataxia

• Death of brain cells due to lack of enough oxygen or nutrients as in stroke also leads to ataxia

• A temporary reduction in the blood flow to brain due to transient ischemic attack (TIA) causes ataxia

• Brain damage during development causes cerebral palsy, one of the causes of ataxia

• Multiple sclerosis affects different part of brain including the regions controlling voluntary movements

• Ataxia is one of the complication of chicken pox and other viral infections

• Paraneoplastic syndromes, disorders caused by the reaction of immune system to tumor, also cause ataxia

• Cerebellar tumor damages the region controlling voluntary movements

• Certain medications like barbiturates and sedatives may cause ataxia as a side effect

• Deficiency of vitamin B-12 also may result in this condition

• In some cases, no specific cause can be implied in the development of this disorder and is known as sporadic degenerative ataxia.

Certain genetic defects are also known to cause this condition. The abnormal proteins produced by the defective gene affect the function of nerve cells resulting in their degeneration.

Hereditary or genetic form of ataxia may be produced by autosomal dominant or autosomal recessive disorder.

Spinocerebellar ataxias and episodic ataxia are autosomal dominant ataxias.

• Friedreich's ataxia,
• congenital cerebellar ataxia,
• ataxia-telangiectasia,
• Wilson disease

are inherited as autosomal recessive forms.

Diagnosis of ataxia is based on physical examination, review of symptoms, and neurological evaluations.

Neurological examination assesses

• vision,
• memory,
• concentration,
• hearing,
• balance,
• coordination and reflexes.

Imaging studies like CT scan and MRI help to detect and locate the abnormalities in brain. A spinal tap or lumbar puncture also is recommended to diagnose the cause of ataxia.

In this procedure, the cerebrospinal fluid sample is removed from the lower back by inserting a needle between the two lumbar vertebrae.

Gene mutations that cause ataxia are detected using genetic testing. 

There is no complete cure for Ataxia, however, there are treatments that can alleviate symptoms.

Ataxia caused by underlying conditions resolve when the condition is treated successfully. Treatment helps to improve the quality of life by using supportive and assistive devices.

Adaptive devices like

• walkers,
• modified vessels for eating
• communication aids for speaking

are of help.

Physical therapy is recommended to improve the strength and flexibility of the muscles.

Occupational therapy helps the person to carry on with daily routine, while speech therapy is helpful in improving speech.

Muscle spasms and uncontrolled movements of eyes are controlled by medications. 

There is no standard way to prevent ataxia.

Preventing or treating the medical conditions that cause ataxia may be of help. 

Homeopathic remedies used for treatment of locomotor ataxia are:

• Argentum nitricum,
• alumina,
• secale cornutum,
• silicea.

Biofeedback and ayurveda are used in treatment of ataxia to improve coordination and balance.

Vitamin E and Acetyl-dl-leucine supplementation are also suggested in treating specific symptoms of ataxia.

Lifestyle modifications are necessary in order to cope with ataxia.

The loss of independence due to ataxia often leads to anxiety.

Counseling and therapy help to cope with the situation.

Joining a support group for ataxia or for the underlying medical condition, like tumor or multiple sclerosis, also may be of help.

These groups are good sources of information and a good platform for sharing experiences. 

Symptoms of ataxia may become permanent in many people, particularly in acute cerebellar ataxia.

Anxiety and depression are also complications of ataxia.