Ataxia

Ataxia can appear in different forms depending on the underlying cause:

• Cerebellar ataxia: Caused by damage to the cerebellum, leading to unsteady gait, tremors, or difficulty with coordinated tasks.
• Sensory ataxia: Caused by damage to nerves or the spinal cord, leading to loss of joint position sense (awareness of limb position).
• Vestibular ataxia: Caused by problems in the inner ear or balance pathways, often associated with vertigo (spinning sensation).
• Hereditary ataxias: Genetic conditions such as spinocerebellar ataxias (SCAs) that gradually worsen over time.

Ataxia can affect movement, speech, and coordination. Common signs include:

• Unsteady walking or frequent stumbling
• Difficulty with tasks requiring precision, such as writing or buttoning clothes
• Slurred speech
• Poor coordination of hands, arms, or legs
• Tremors or involuntary eye movements

Ataxia can be caused by a wide range of conditions, including:

• Toxins: Excessive alcohol, drugs (phenytoin and lithium), heavy metals (mercury and lead), or poisons (cyanide)
• Stroke: Interruption of blood supply to the brain (ischemic) or bleeding into the brain (haemorrhagic)
• Inflammatory conditions: demyelinating disorders (diseases that damage the protective covering of nerves)
• Malignancy: Primary brain tumours or metastasis, paraneoplastic syndromes
• Infections: Like herpes or measles affecting the nervous system
• Neurodegenerative diseases: Like Multiple System Atrophy Cerebellar type (MSA-C) and Spinocerebellar Ataxias (SCAs)
• Nutritional deficiencies: Like vitamin E deficiency, Wernicke’s encephalopathy
• Loss of joint position sense secondary to involvement of peripheral nerves or spinal cord
• Neuropathies: Such as chronic inflammatory demyelinating polyneuropathy and paraproteinemic neuropathy
• Disorders of metabolism: For example, Refsum’s disease
• Immune-related disorders: Paraneoplastic syndrome (immune reaction due to cancer) or Sjogren’s syndrome
• Spinal cord disorders: Such as spondylosis or demyelination

Doctors use several tests to determine the cause of ataxia:

• Physical and neurological exams: To assess coordination, reflexes, and balance.
• Blood tests: To check for vitamin deficiencies, thyroid function, infections, or toxins.
• Genetic testing: To identify inherited forms of ataxia.
• Imaging studies: MRI or CT scans to detect brain or spinal cord abnormalities.

There is no single treatment for ataxia—it is based on the underlying conditions:

• Correcting deficiencies: Vitamin supplements if caused by nutritional deficiencies.
• Stopping harmful substances: Avoiding alcohol, medications, or toxins responsible for symptoms.
• Treating underlying disease: For example, managing stroke, multiple sclerosis, or tumours.
• Rehabilitation: Physical, occupational, and speech therapy to improve balance, coordination, and communication.
• Medications: Used in some cases to manage tremors, stiffness, or other associated symptoms.

Seek medical attention if you notice:

• Sudden loss of balance or difficulty walking.
• Trouble coordinating hand or leg movements.
• Slurred speech or difficulty swallowing.
• Unexplained tremors or unsteadiness.

Not all types of ataxia can be prevented, especially genetic forms; however, risk can be reduced by:

• Avoiding excess alcohol and harmful substances.
• Protecting against head injuries.
• Managing chronic illnesses like diabetes, thyroid disease, or high blood pressure.
• Ensuring proper nutrition with adequate vitamins.

Patients with ataxia should consult a Neurologist (for diagnosis and treatment of the underlying cause).