Ataxia: symptoms, causes and treatment

By Cristiano Antonino On Jan 27, 2023

The term ataxia refers to the decrease or loss of coordination in voluntary movements, such as walking or picking up objects

A sign of an underlying disease, this condition can create different types of difficulties, for example in pronouncing words, moving the eyes and swallowing.

Sufferers may stumble, fall, have problems with the use of fingers, hands, arms, legs.

Ataxia affects people of all ages and the onset of symptoms can occur at any time of life, from childhood to late adulthood.

What is ataxia

Typically, persistent ataxia results from damage to the part of the brain that controls muscle coordination, balance, eye movements, swallowing and speech: the cerebellum.

Diseases that damage the spinal cord and the peripheral nerves that connect the brain to the muscles can also cause ataxia.

Underlying this condition can be many conditions, including alcohol abuse, certain medications, strokes, tumours, cerebral palsy, cerebral degeneration and multiple sclerosis.

Treatment depends on the cause and often involves a combination of drugs to treat the symptoms and various therapies to improve the patient’s quality of life.

Ataxia, the symptoms

Ataxia can develop progressively or occur suddenly.

The intensity and type of symptoms vary from person to person.

In any case, the most common signs and signals are

decreased ability to coordinate movements
loss of balance;
unsteady walking,
gait abnormalities and tendency to stumble;
impairment of fine motor skills, such as eating, writing or buttoning a shirt;
involuntary eye movements;
difficulty swallowing;
slurring;
tremors.

Causes of ataxia include:

trauma to the head: a trauma or blow to the head, e.g. from a car accident, can cause damage to the brain or spinal cord, which in turn can lead to acute ataxia, which occurs suddenly;
stroke: a blockage of the cerebral circulation, such as a haemorrhage in the brain, can cause ataxia. When the blood supply to a part of the brain is interrupted or severely reduced, depriving the brain tissue of oxygen and nutrients, brain cells die, triggering various consequences.
Cerebral palsy: this is a general term for a group of disorders caused by damage to a child’s brain before, during or immediately after birth. They affect the child’s ability to coordinate body movements;
autoimmune diseases: multiple sclerosis and other autoimmune conditions can cause ataxia;
infections: ataxia can be a rare complication of chickenpox and other viral infections such as HIV and Lyme disease. It may appear in the healing stages of the infection and last for days or weeks. Normally, ataxia resolves over time in these cases;
paraneoplastic syndromes: these are rare, degenerative diseases triggered by the immune system’s response to a tumour, most commonly lung, ovarian, breast or lymphatic cancer. Ataxia may appear months or years before the cancer is diagnosed;
abnormalities in the brain: either an abscess or a mass (malignant or benign) in the brain can damage the cerebellum, causing ataxia;
toxic reaction: ataxia is a potential side effect of certain drugs, in particular certain types of barbiturates, sedatives, anti-epileptics, chemotherapeutics. These causes are particularly important to identify because the effects are often reversible;
alcohol and drug intoxication; heavy metal poisoning, such as lead or mercury; solvent poisoning, e.g. from paint thinner: these are all possible causes of ataxia;
deficiency of vitamin E, vitamin B-12 or thiamine: lack of one of these nutrients, whatever the cause, can lead to ataxia;
thyroid problems: both hypothyroidism and hypoparathyroidism can cause ataxia:
covid19 infection: this infection can also cause ataxia, most commonly in very severe patients.

Hereditary ataxias

In some adults who develop sporadic ataxia, no specific cause of the disease can be identified.

Sporadic ataxia can take several forms, including multisystem ataxia, a progressive and degenerative disease.

In addition, there are also hereditary forms of ataxia, linked to the presence of genes that produce abnormal proteins, which hinder the function of nerve cells, mainly in the cerebellum and spinal cord, and cause them to degenerate.

Ataxia, what tests to do

In the presence of suspicious symptoms, it is a good idea to consult your doctor, who may refer you to a neurological specialist for a more in-depth analysis of the situation and a diagnosis.

In addition to conducting a physical examination and a neurological test, which include, among other things, checking vision, hearing, balance, coordination and reflexes, the neurologist may request some laboratory tests, including

a CT scan and/or MRI of the brain and spinal cord, to check for abnormalities affecting the cerebellum and/or other brain or spinal cord structures, blood clots or masses that could press on the cerebellum;
a spinal tap, which consists of inserting a needle into the lower back (lumbar region) between two vertebrae to take a sample of cerebrospinal fluid, the fluid that surrounds and protects the brain and spinal cord. The sample taken will then be sent to a laboratory for tests to detect any infection or other diseases;
genetic testing: the doctor may recommend genetic testing to determine the presence of any genetic mutations associated with ataxia.

How ataxia is treated

Unfortunately, to date there is no specific cure for this condition.

However, there are treatments that can improve the situation.

The doctor may either recommend therapies for symptom management or suggest the use of adaptive devices that help the patient overcome certain difficulties.

Indeed, the goal of ataxia treatment is to improve the patient’s quality of life and to achieve this, an individualised and ‘tailor-made’ approach is needed more than ever.

In some cases, it is sufficient to resolve the underlying cause to also cure ataxia, for example if the cause is the use of certain drugs, discontinuing them will also eliminate the ataxic disorder.

It should also not be forgotten that in certain situations, ataxia tends to heal spontaneously, for example when it results from chicken pox or other viral infections.

If ataxia is associated with vitamin E deficiency, it can be treated with supplements of this vitamin, while if it is associated with deficient neuropathy, specific supplements may be useful.

When it is caused by conditions such as multiple sclerosis or cerebral palsy, trekking poles or walkers that support while walking, modified eating utensils, and communication aids for speech may be indicated.

Some patients may benefit from specific approaches, such as physiotherapy to aid coordination and improve mobility, occupational therapy to learn coping strategies for activities of daily living, and speech therapy to improve speech and swallowing skills.

For this, the neurologist may collaborate with other specialists such as the physiatrist and orthopaedist or with professionals such as the physiotherapist, speech therapist and psychologist.

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