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Ataxia - Treating ataxia

NHS Choices Medical Reference

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If you have hereditary ataxia, you'll have a care plan outlining your treatment needs.

If you have acquired ataxia, your treatment will depend on the underlying cause and how long your symptoms are likely to persist.

Hereditary ataxia

Multidisciplinary teams (MDTs) are used to manage cases of hereditary ataxia. MDTs are made up of healthcare professionals who bring different areas of expertise together into a team.

For example, your care team may include:

  • a neurologist - a specialist in conditions that affect the brain and nervous system
  • a cardiologist - a heart specialist
  • an ophthalmologist - an eye specialist
  • a urologist - a specialist in bladder conditions
  • a physiotherapist - a therapist who helps people improve their co-ordination and range of movement
  • a speech and language therapist
  • a psychologist - a mental health specialist
  • a social worker
  • an occupational therapist - a therapist who helps people improve the skills they need for carrying out daily activities, such as washing and dressing
  • a specialist neurology nurse  - who will usually be your first point of contact with the rest of the team

As hereditary ataxia is a very rare condition, if you are diagnosed with this you may be referred to a specialist ataxia centre.

Your care plan will play an important part in the management of your condition. Your physical, social and psychological needs will be assessed and the plan will outline how these needs can best be met. The plan will also address any future needs you may have.

There are some types of hereditary ataxia where it's possible to control symptoms. These include:

  • ataxia with vitamin E deficiency  - this can be treated using vitamin E supplements
  • episodic ataxia type 2 - this can be treated using a medication called acetazolamide

In most cases of ataxia it's not possible to eliminate the symptoms. Treatment provides support to help you cope better with your symptoms. This is known as symptomatic treatment.

Treatments for the various symptoms are discussed below, although it's important to note that you may not experience all of the symptoms described.

Speech and language therapy (SLT)

A speech and language therapist will be able to help with two of the most common symptoms of ataxia - slurred speech (dysarthria) and swallowing problems (dysphagia).

The therapist will be able to advise you about how to make your voice sound clearer. For example, they may suggest:

  • changing your posture to improve the quality of your voice
  • carrying out exercises to strengthen the muscles used when speaking
  • speaking more slowly to emphasise each word 
  • using breathing techniques to improve your speech

If your speech gets worse, you may want to consider using speaking aids such as a laptop computer connected to a voice synthesizer. Your therapist will be able to advise you about the equipment available.

To treat dysphagia, your therapist will be able to teach you exercises to stimulate the nerves used to trigger your swallowing reflex and strengthen the muscles used when swallowing.

You may also be referred to a dietitian for dietary advice. For example, your diet may need to include food that's easier to swallow and you should also eat a healthy, balanced diet.

Read more about treating dysphagia.

Occupational therapy

The aim of occupational therapy is to teach you how to adapt to your gradual loss of mobility and to develop new skills you can use to carry out daily activities.

An occupational therapist will be able to teach you how to use a wheelchair and other mobility devices. They can also advise you about modifications you can make to your house, such as installing guide rails or a stair lift, to help make your life easier.

Read more about occupational therapy.

Physiotherapy

If you have ataxia, physiotherapy can help prevent your muscles from weakening or getting stuck in one position (contracture).

A physiotherapist will be able to teach you a number of physical exercises you can do every day to help strengthen and stretch your muscles. Special arm or leg braces may also be used to help stretch your muscles.

Read more about physiotherapy.

Muscle problems

If you're experiencing muscle spasms, cramps and stiffness, muscle relaxant medication such as baclofen or tizanidine can be used to control these symptoms.

If muscle relaxants are not effective, an injection of botulinum toxin may be given. It works by blocking the signals from your brain to the affected muscles.

The effects of the injection will usually last for up to three months.

Bladder problems

Bladder problems, such as urinary urgency or rarely urinary incontinence, sometimes affect people with hereditary ataxia.

In some cases, bladder problems can be controlled using a number of self-care techniques, such as limiting fluid intake during the day and avoiding drinks known to stimulate urine production, such as caffeine and alcohol.

Some people may also require a type of medication known as antimuscarinic. This will help relax the bladder, reducing the frequent urge to urinate.

Others may find it difficult to empty their bladder completely when they go to the toilet. This can lead to small amounts of urine leaking out later on.

In such cases, it may be necessary to insert a small tube known as a catheter into the bladder to help drain the urine.

Read more about urinary catheterisation.

Eye problems

Eye problems are also common in cases of hereditary ataxia.

Oscillopsia is an eye problem caused by involuntary movement of the eyes from side to side or up and down. It can cause visual disruption, making tasks such as reading difficult.

Oscillopsia can sometimes be treated using medication such as gabapentin to control the muscles that move the eyes.

A more common eye problem that can occur is double vision, where you see two images of a single object.

It may be possible to treat double vision by attaching a wedge-shaped piece of glass or plastic called a prism to your glasses. 

Erectile dysfunction

As a result of underlying nerve damage, some men with hereditary ataxia will experience erectile dysfunction (difficulty getting or maintaining an erection).

Erectile dysfunction in cases of ataxia can often be treated using a group of medications known as phosphodiesterase-5 (PDE-5) inhibitors, such as Viagra (sildenafil). These help increase blood flow to the penis.

Read more about treating erectile dysfunction.

Fatigue

Many people with neurological conditions such as ataxia report feeling extremely tired and lethargic (lacking in energy).

It's thought this is partly caused by disturbed sleep and the physical efforts of having to cope with the loss of co-ordination. Patients with multiple sclerosis may complain of severe fatigue.

A physiotherapist should be able to teach you exercises to increase your stamina levels, and an occupational therapist can advise you about how to adapt your daily activities to help you cope with fatigue better.

Read more about coping with fatigue.

Neuropathic pain

Damage to the nerve endings can result in nerve pain. The medical term for nerve pain is neuropathic pain, which is often experienced as a burning, aching or shooting pain, or sometimes tingling, in certain parts of the body.

Traditional painkillers such as paracetamol or ibuprofen aren't usually effective in treating neuropathic pain, so you may be prescribed a number of medications, such as amitriptyline, gabapentin or pregabalin.

Read more about treating neuropathic pain.

Cardiomyopathy

Cardiomyopathy (damage to the heart muscle) is a common complication of Friedreich's ataxia, occurring in one in two cases.

Left untreated, cardiomyopathy can be serious as it can place strain on the heart, affect the normal blood flow through the heart and cause heartbeat irregularities (arrhythmias).

If you develop cardiomyopathy, you'll receive regular check-ups from a cardiologist (a heart specialist).

Cardiomyopathy is difficult to treat and there is no known cure.  

Depression

Living with a long-term condition such as ataxia can be stressful and can often cause intense feelings of anxiety.

In some cases, this can trigger the onset of depression. Signs that you may be depressed include:

  • feeling down or hopeless during the past month 
  • no longer taking pleasure in the things you enjoy

You should contact your GP for advice if you think you may be depressed. There are several relatively effective treatments for depression, such as antidepressant medication and talking therapies such as cognitive behavioural therapy (CBT).

You may also find it useful to contact Ataxia UK, a leading charity for people affected by ataxia.

Their helpline number is 0845 644 0606 and is open Monday to Thursday from 10.30am-2.30pm.

Acquired ataxia

The recommended treatment for acquired ataxia depends on the underlying cause and whether your symptoms are likely to persist on a long-term basis.

For example, if ataxia is caused by a complication of an infection, using antibiotics or antivirals to treat the underlying infection should help resolve the symptoms.

If the ataxia is caused by serious underlying brain damage, such as damage as a result of a stroke or a severe head injury, it's likely that the symptoms will persist. If this is the case, your ataxia will be treated in the same way as hereditary ataxia.

Idiopathic late onset cerebellar ataxia (ILOCA)

Idiopathic late onset cerebellar ataxia (ILOCA), where the cerebellum is gradually damaged over time, is treated in the same way as hereditary ataxia.

However, the symptoms of ILOCA tend to be less severe and wide ranging, so you shouldn't need many of the treatments discussed above.

Medical Review: July 02, 2013
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