Treatment for cerebellar ataxia depends on the underlying cause of the condition and can include medication, physical therapy, mobility aids, and more.

What is Cerebellar Ataxia?

Ataxia is a medical term used to describe a lack of muscle control or coordination. Cerebellar ataxia refers to the lack of control or coordination caused by issues with the cerebellum. The cerebellum is the part of the brain which helps to control voluntary movements and create a smooth gait.

People with cerebellar ataxia can have a variety of symptoms, including:

• Poor coordination
• Unsteady walk
• Tendency to stumble
• Difficulty with fine motor skills
• Change in speech
• Difficulty swallowing
• Dizziness
• Headaches
• Involuntary back and forth eye movements (nystagmus)

What Causes Cerebellar Ataxia?

Generally, the cause of cerebellar ataxia is inflammation of or damage to the cerebellum.

Acute (short term) cerebellar ataxia could be caused by head trauma, a stroke, a tumor, or other injuries that cause the death of brain cells. Viral infections could also contribute to ataxia, although these are rarer.

In some cases, ataxia can be a result of an adverse drug reaction. This has been recorded with certain sedatives, chemotherapy medications, and more. For example, cerebellar ataxia may be a consequence of taking Dilantin (phenytoin) for a long period of time.

Dilantin is a medication used to treat various types of seizures and has reportedly been linked to the development of cerebellar atrophy, a condition that can lead to ataxia. Similarly, acute ataxia may appear due to alcohol and drug intoxication or poisoning from lead, mercury, or other toxic chemicals.

Chronic (long term) cerebellar ataxia may be caused by conditions that cause progressive damage to the cerebellum, such as autoimmune conditions, multiple sclerosis, cerebellar disorders, and more. This type of ataxia could also be caused by hereditary conditions which make a person more likely to develop ataxia or other cerebellar issues. Although it is rare, ataxia could also be a part of a paraneoplastic syndrome – conditions that develop when the immune system attempts to fight cancer.

How Does Phenytoin Cause Cerebellar Ataxia?

The mechanism by which phenytoin (Dilantin) impacts the cerebellum is not completely understood. The drug targets what are known as voltage-gated sodium channels. These regulate the flow of electrical energy across cell membranes and thus play a significant role in signaling within the brain. By selectively targeting sodium channels, phenytoin is able to block the excess electrical activity that neuroscientists believe cause seizures.

Although scientists have yet to determine exactly how phenytoin causes cerebellar degeneration, a recent study published in the journal Seizure found that cerebellar ataxia and atrophy was present in 40 percent of epileptic patients who took the medication over an extended period of time, even though they did not exhibit symptoms. The degree of atrophy appears to be related to how long the drug is taken rather than the dosage.

According to the study cited in Seizure, 47 patients who had been prescribed Dilantin for a median of 15 years were recruited. More than half of these patients reported difficulties with balance, and clinical ataxia was present in approximately 40 percent of cases. However, only one patient in the study was found to have levels of phenytoin higher than the normal range. This may indicate that even patients on Dilantin who do not have clinical evidence of ataxia may be suffering from reduced cerebellar volume.

Additionally, some studies have indicated that patients over the age of 70 who have been prescribed phenytoin to control seizure disorders may be even more likely to suffer from issues related to their balance.

In addition to the dangers of developing cerebellar atrophy after taking Dilantin, patients may also be at risk of developing phenytoin poisoning. Although phenytoin toxicity is rare, it can result in neurological symptoms including ataxia, and even coma.

Other side effects of Dilantin may include headache, nausea, vomiting, constipation, dizziness, drowsiness, sleeping trouble, anxiety, or swelling and bleeding of the gums. More serious side effects may include double or blurred vision, tingling in the hands and feet, facial changes or swelling, skin changes or rash, excessive hair growth, joint pain, or easily broken or fractured bones.

What is the Treatment for Cerebellar Ataxia?

Treatment for cerebellar ataxia may depend on the cause behind the condition. In a few acute cases, the cause of ataxia can be reversed, but most situations do not have a cure.

In situations with no cure, treatment for cerebellar ataxia may focus instead on limiting the adverse side effects of the condition. This can include physical therapy, occupational therapy, speech therapy, and other forms of treatment that aim to retain independence and reduce symptoms. Patients may also be given adaptive devices (canes, walkers, etc.) in order to help manage their condition.

Depending on the cause of the cerebellar ataxia, medications may also be used to manage the condition, although the exact prescription will vary.

In some cases, the treatment for cerebellar ataxia may be as simple as withdrawing the patient from the medication. If cerebellar ataxia was caused by an adverse reaction to a medication such as Dilantin, the condition may be reversible. Although some cases of Dilantin cerebellar ataxia have been persistent after the medication is stopped, some patients have reportedly been able to recover from the condition after phenytoin discontinuation.