Medicines for Ataxia

What it is

Ataxia is a term for problems with coordination, balance, and movement, caused by damage to or a problem with the part of the nervous system that controls these — most often the cerebellum (the part of the brain that coordinates movement) or its connections. "Ataxia" describes the symptom (loss of coordination), and there are many possible underlying causes. The features of ataxia can include: unsteady, clumsy, or uncoordinated movements; problems with balance and walking (an unsteady, staggering gait); difficulty with fine movements and tasks needing coordination (such as writing or doing up buttons); slurred or unclear speech (as coordination of the speech muscles is affected); problems with eye movements; and sometimes difficulty with swallowing or other functions. The severity and pattern depend on the cause and which parts are affected. Ataxia has many possible causes, which can be broadly grouped into: acquired ataxias, caused by damage from another problem — such as a stroke, a head injury, a tumour, multiple sclerosis, alcohol (long-term heavy use), certain vitamin deficiencies, some infections, certain medicines or toxins, or other conditions (some of these are treatable, particularly if the cause can be addressed); and hereditary (genetic) ataxias, which are inherited conditions (such as Friedreich’s ataxia and others) that usually cause a progressive ataxia, often beginning in childhood or early adulthood. There is also a group of conditions where ataxia occurs as part of a progressive neurological condition. Because ataxia is a symptom with many causes, an important part of care is identifying the underlying cause, as this determines the treatment and outlook — some causes are treatable or reversible (for example, a vitamin deficiency, or stopping a causative substance), while for progressive or genetic ataxias there may not be a cure, and care focuses on managing symptoms, maintaining function, and support. Whatever the cause, support such as physiotherapy, occupational therapy, and speech and language therapy helps people manage the effects of ataxia, maintain function and independence, and adapt. The key messages are that ataxia is a problem with coordination, balance, and movement with many possible causes, that identifying the cause guides treatment (some causes are treatable), and that support helps people manage the effects.

How it is treated

Ataxia is managed by identifying and treating the underlying cause where possible, and by supporting function and managing symptoms with therapies and adaptations; the approach depends greatly on the cause. Because ataxia is a symptom of many possible underlying conditions, an important first step is assessment to identify the cause — this involves a neurological assessment and tests, which may include brain and other scans (such as MRI), blood tests (for example to check for vitamin deficiencies or other causes), genetic testing (for suspected hereditary ataxias), and other investigations, guided by a specialist (neurologist). Identifying the cause is important because it determines the treatment and outlook: some causes of ataxia are treatable or reversible — for example, treating a vitamin deficiency (such as vitamin E or B12), stopping a causative substance (such as alcohol or a medicine), or treating an underlying condition — and addressing these can improve or resolve the ataxia; other causes (such as a stroke) are treated as the underlying condition, with the ataxia then managed and rehabilitated. For progressive or hereditary ataxias, there may not be a cure, and care focuses on managing symptoms, maintaining function and quality of life, and support, with treatment of any specific aspects that can be helped. Regardless of the cause, supportive therapies are central to helping people manage the effects of ataxia and maintain function and independence: physiotherapy helps with balance, coordination, walking, and strength, and can include exercises and mobility aids; occupational therapy helps with daily living skills, aids, and adaptations; and speech and language therapy helps with any speech difficulties and, where relevant, swallowing. Managing any associated symptoms (such as fatigue, or others depending on the cause) and providing aids and adaptations support daily life. For hereditary ataxias, genetic counselling is offered, and support organisations for ataxia provide information, support, and community. Ongoing support, monitoring, and multidisciplinary care help people adapt to and manage the condition, particularly for progressive forms. The reassuring messages are that ataxia is a symptom with many causes, that identifying the cause is important (as some causes are treatable or reversible), and that, whatever the cause, supportive therapies (physiotherapy, occupational therapy, and speech and language therapy) and adaptations help people manage the effects, maintain function and independence, and adapt; so assessment to find the cause and access to appropriate treatment and support are the keys to managing ataxia.