There is no cure for cerebellar ataxia but the condition can be managed and treated with varying levels of success usually depending on the underlying cause.

What Is Cerebellar Ataxia?

Ataxia is the medical term for lack of muscle control or coordination. The condition is caused when inflammation or damage harms the way that cerebellum works. The cerebellum is the part of the brain that controls muscle coordination and voluntary movements. This includes walking and picking up objects.

Cerebellar ataxia can include a variety of symptoms such as:

• Poor coordination
• Unsteady gait
• A tendency to stumble while walking
• Difficulty with fine motor tasks (eating, writing, buttoning a shirt, etc.)
• Change in speech
• Slurred speech
• Headaches
• Dizziness
• Nystagmus (involuntary back and forth eye movements)
• Difficulty swallowing

What Causes Cerebellar Ataxia?

Several conditions and factors can lead to cerebellar ataxia, including:

• Alcohol abuse
• Head trauma
• Medications
• Stroke
• Seizures
• Brain tumors
• Cerebral palsy
• Brain degeneration
• Multiple sclerosis (an autoimmune condition that affects the nervous system)
• Vitamin deficiencies
• Hereditary genes

Although medications such as sedatives and chemotherapy are linked to cerebellar ataxia, epilepsy medications such as Dilantin (phenytoin) may also be linked to the disease.

Several studies have linked long term phenytoin exposure to cerebellar degeneration and subsequent ataxia. One 2018 United Kingdom study aimed to determine how likely phenytoin patients were to develop cerebellar ataxia and found that a significant percentage of patients were at risk.

The researchers examined 47 patients who were recruited from epilepsy clinics at the Royal Hallamshire Hospital in Sheffield, UK. These patients had suffered from epilepsy for a median of 24 years and had been treated with Dilantin for a median of 15 years. After this long term treatment, neurological examinations were conducted to see how patients’ cerebellums fared.

Clinical evidence reportedly showed that 40 percent of patients developed cerebellar ataxia after being treated with phenytoin. Some visible symptoms such as gait, stance, and walking capabilities were examined to screen for ataxia. Additionally, MRI scans of the patients showed that those affected by cerebellar ataxia suffered from structural and functional deficits in their cerebellum.

Of the 40 percent of patients with ataxia, only one had phenytoin levels above the normal range. This may indicate that this neurological complication can occur even if drug serum levels are normal.

“Cerebellar ataxia is present in 40 percent of patients with epilepsy and chronic exposure to phenytoin,” the researchers concluded. “Patients on long-term phenytoin have reduced cerebellar volume even if they have no clinical evidence of ataxia.”

One complication in conducting phenytoin cerebellar degeneration research is that patients with epilepsy are also at risk for developing the condition. This means that researchers must consider the fact that patients may already be at risk by virtue of having a seizure condition.

Practical Neurology explains that ataxia can progress in a range of ways. Its progression may be dependent on the kind of ataxia it is, or the potential cause. Identifying the length of onset can be a way to identify the case, and subsequently the cure for cerebellar ataxia, if one is possible.

Ataxia progress abruptly, in the case of damage to the brain like a stroke or a brain lesion. According to Practical Neurology, in which case that the cerebellum is inflamed, either because of infection or another cause, then ataxia can progress abruptly.

In cases in which the cerebellum (along with the rest of the brain) is exposed to a toxin in a short period of time, abrupt ataxia may occur. Other conditions not necessarily specifically connected to the cerebellum may result in acute and abrupt onset ataxia, such as auto-immune disorders like multiple sclerosis.

Some ataxia cases progress over the course of weeks or months. Vitamin deficiencies can affect the cerebellum, and can result in ataxia that presents over the course of weeks or months. Not all ataxia cases are related to degeneration or damage to the cerebellum, and some of these other kinds of ataxia can develop over the course of weeks or months. 

On the other end of the spectrum, ataxia may develop slowly over the course of months or years. Extended exposure to toxins can also take their toll on the cerebellum. Toxins that usually affect a brain over a long period of time can include alcohol used regularly and in excess, as well as medications taken regularly over a long period of time. Additionally, genetic ataxias usually develop over this extended time frame.

Is There a Cure for Cerebellar Ataxia?

A cure for cerebellar ataxia is not straightforward since it can be caused by a number of temporary or permanent conditions. Patients who experience ataxia due to a temporary problem like an infection or drug side effect will likely recover with no problems. Unfortunately, most patients who suffer from debilitating cerebellar ataxia will not recover.

Instead of looking to cure cerebellar ataxia completely, most doctors reportedly focus on improving quality of life and managing symptoms.

How Is Cerebellar Ataxia Treated?

One of the most essential steps in cerebellar ataxia treatment is determining the underlying cause. For example, if a patient develops cerebellar ataxia after taking Dilantin for seizures, a doctor can treat the condition by taking them off the medication. Another example is ataxia from vitamin deficiencies; administering a vitamin injection or prescription can help to resolve the condition.

As mentioned above, treating cerebellar ataxia is not always an easy fix. Treatment for permanent cerebellar ataxia may include things like adaptive devices and therapies.

Adaptive devices include objects which help the patient function as normally as possible despite their condition. One common example of an adaptive device is a walker or hiking stick to assist with walking. Other adaptive devices include modified utensils that help with eating and communication aids to help with speaking.

In addition to adaptive devices, patients with cerebellar ataxia may benefit from a variety of therapies. Physical therapy can help patients with their coordination and enhance their mobility. This therapy mostly focuses on building muscle or flexibility in the body.

Occupational therapy may also help patients as they figure out ways to complete daily tasks such as getting dressed and eating. If patients are struggling with their speech, speech therapy can help with these symptoms and may lessen difficulties swallowing.

Patients with permanent ataxia may also benefit from emotional support like group or individual therapy to help work through the resulting emotions following a cerebellar ataxia diagnosis.