Cerebellar ataxia, or cerebellar ataxia, is a set of symptoms related to coordination of movement, balance, and posture that occur as a result of lesions and inflammation in the cerebellum. In this article we will describe the symptoms, causes and main treatments of cerebellar ataxia .
What is cerebellar ataxia?
The term “ataxia” is used to refer to a syndrome characterized by symptoms such as lack of balance and coordination . When these disorders are due to dysfunctions in the cerebellum, the back structure of the brain, the concept of “cerebellar ataxia” or “cerebellar” is used.
Although until a few years ago it was believed that the cerebellum was mainly involved in functions related to movement coordination, it is now known that it also plays a relevant role in language, cognition and emotion.
Because of this multiplicity of tasks, lesions and inflammations in the cerebellum not only cause ataxia but also other disparate symptoms associated with the processes and functions we have mentioned.
There are two main types of cerebellar ataxia : acute and chronic. We speak of “acute cerebellar ataxia” when the symptoms appear abruptly, and we say that it is chronic when they develop progressively.
Acute cerebellar ataxia is more common than chronic. It is common for it to appear in infants and young children in the period following an illness. Chronic cerebellar ataxia is often associated with structural neurological disorders, such as those caused by trauma, tumors, and autoimmune diseases.
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Characteristic signs and symptoms
The main symptoms of cerebellar ataxia are related to the coordination of movements of different parts of the body , since it is these types of signs that define ataxia. However, other changes associated with damage to the cerebellum are more common.
Scientific research has determined that these symptoms and signs occur on the ipsilateral side of the body, i.e. in the same hemisphere as the lesion in the cerebellum.
- Lack of coordination (dyssynergy) of trunk and limbs
- Disorderly gait, frequent stumbling
- Fine motor deficit
- Difficulties in executing rapid and alternating movements (dysdiadocinesia)
- Lack of balance and postural disorders
- Eye nystagmus (involuntary eye movements)
- Instability of gaze
- Disorders in speech, mainly in phoneme articulation (dysarthria)
- Difficulties swallowing food and liquids
- Symptoms of depression and anxiety
- Behavior and personality changes
- Dizzy sensations
- Late development of multiple systemic atrophy (in one third of patients)
Causes of this alteration
The cerebellum or any other part of the nervous system can be damaged and inflamed by many different causes; therefore, the reasons for the appearance of cerebellar ataxia are also very numerous.
Below we will describe some of the most common ones.
1. Genetic inheritance
There are different forms of ataxia caused by the inheritance of genetic defects that alter the synthesis of proteins necessary for the normal functioning of the nervous system, and which mainly affect the cerebellum and the spinal cord.
Spinocerebellar and episodic ataxias are inherited through an autosomal dominant mechanism, while Wilson’s disease, Friedrich’s ataxia, ataxia-telangiectasia and congenital cerebellar ataxia are transmitted by autosomal recessive inheritance.
2. Head injuries
One of the most common causes of cerebellar ataxia is head trauma ; for example, it is common for the cerebellum to be damaged as a result of traffic accidents, when the back of the skull is hit against the seat.
Strokes, such as ischemia, can alter the circulatory flow to the cerebellum and other regions. If the tissue is deprived of nutrients and oxygen, it can become necrotic, causing damage to the affected area.
4. Infectious diseases
Chickenpox, Lyme disease and other infectious diseases are common causes of this syndrome, especially in young children. It usually appears during the recovery period and usually only lasts a few weeks.
5. Autoimmune diseases
Autoimmune diseases that can cause symptoms of cerebellar ataxia include multiple sclerosis and sarcoidosis.
6. Tumors in the brain
The appearance of tumors near the cerebellum often causes damage to this structure, even if they are benign tumors . Paraneoplastic syndromes, caused by pathological responses of the immune system to the development of cancer, have also been associated with cerebellar ataxia.
7. Exposure and consumption of substances
Exposure to human toxins such as lead and mercury can cause symptoms of cerebellar ataxia, as can chemotherapy. Abuse of alcohol or certain types of anti-anxiety drugs , especially barbiturates and benzodiazepines, can cause harmful reactions in the cerebellum and the rest of the nervous system.
Treatment of cerebellar ataxia
Since cerebellar ataxia can appear as a consequence of a large number of causes, the most appropriate treatment for each case will depend on the specific alteration that has caused the symptoms. This multiplicity of causal factors makes identification of the underlying problem particularly important in ataxia.
Acute cerebellar ataxias tend to progressively disappear within weeks; conversely, and by definition, chronic ataxia is more difficult to treat and may have to be managed by supportive therapy alone.
Rehabilitation can be effective in reducing problems related to posture and motor skills. Focused exercise therapy programs that work on coordination and balance are applied with some frequency.
Buspirone, an anxiolytic from the azapirone group , has been shown to be useful in the treatment of mild and moderate symptoms of cerebellar ataxia, although it is not so useful in more severe cases. Its effects are associated with increased levels of serotonin in the cerebellum.
In recent years, research has begun on the therapeutic efficacy of transcranial stimulation of the cerebellum cortex to enhance its inhibitory activity on movement. The results so far are encouraging but more research is needed to consolidate these interventions in cases of cerebellar ataxia.