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ataxia

Alternative Names
inco-ordination, dyssynergia, ataxy, clumsiness

Definition
Ataxia describes a lack of ability to move the muscles in a co-ordinated fashion. People with ataxia have irregular or awkward movements.

What is going on in the body?
Though most commonly used to describe the way a person walks, this condition can affect any of the muscles in the body. Problems with co-ordination can be due to many different types of problems, ranging from drinking alcohol to having a stroke. Ataxia may cause problems with everyday activities, such as tying a shoelace or driving a car.

What are the signs and symptoms of the condition?
Ataxia itself may cause a person to walk awkwardly, with irregular movements. An example of ataxic movement would be someone who is clearly drunk. Common symptoms may include: But to help make a diagnosis about the actual cause, a doctor may want to know many different things about a person who has co-ordination problems. These may include:
  • when the problem started
  • whether the problem came on quickly or slowly
  • whether the problem is continuous, or if episodes come and go
  • if any family members have co-ordination problems
  • if the person drinks alcohol, takes illegal drugs, or uses any prescription medications
  • if the person has been sick or had a fever lately
  • if the person has ever had a sexually transmitted disease
  • if the person has ever had a head injury
  • if the person has any other medical conditions such as high blood pressure or diabetes
What are the causes and risks of the condition?
There are many possible causes of this condition. Examples include:
  • damage to the brain from head injury, stroke, or Multiple sclerosis
  • infection in the brain, such as meningitis, syphilis, AIDS, or Lyme disease
  • effects of a drug or toxin, such as alcohol, barbiturates, seizure medications or "sniffing glue"
  • poisoning
  • brain tumours or other cancers
  • vitamin deficiencies, such as lack of thiamine or vitamin B12 or vitamin E
  • hormone abnormalities, such as hypothyroidism
  • inherited conditions that affect the brain, such as Friedreich's ataxia, ataxia-telangiectasia or spinocerebellor ataxia
  • bleeding into or around the brain from injury or trauma
  • nerve damage, which often affects walking and may occur with diabetes, lead poisoning, or certain cancer chemotherapy medications
  • old age, which also commonly affects walking. Decreased vision and strength in the elderly also affect walking.
  • hydrocephalus, which is increased fluid on the inside of the brain
  • balance problems due to irritation or damage to the middle ear, which aids in balance. Balance problems may occur with infections of the middle ear, such as Meniere's disease.
Other causes are also possible. Sometimes, a cause cannot be found.

What can be done to prevent the condition?
Prevention depends on the cause. For example, avoiding alcohol will prevent cases caused by drinking alcohol. Practicing safer sex can prevent many cases from syphilis infections or AIDS. Close monitoring of antiepileptic drugs. Many cases cannot be prevented.

How is the condition diagnosed?
The doctor will ask about medical history and perform a physical examination. This should include how muscles and nerves respond. Further testing may be needed depending on the suspected cause.

Blood tests are commonly done. Special x-rays, such as a cranial CT, may be performed. In some cases, a sample of spinal fluid is obtained with a spinal tap. Other tests may be needed in some cases, such as MRI of the brain.

What are the long-term effects of the condition?
Depending on the cause of ataxia, there may or may not be long-term effects. For example, ataxia from alcohol usually goes away when the person is no longer intoxicated. If ataxia is related to a brain tumour or cancer, death may occur. multiple sclerosis can result in permanent disability and severe weakness. Inherited causes often lead to progressive inco-ordination and disability.

What are the risks to others?
In the large majority of cases, there are no risks to others. There may be a risk to others if, for example, a drunk person drives a car. In some cases, an infection is the cause of ataxia. The underlying infection may be contagious.

What are the treatments for the condition?
Treatment is directed at the underlying cause. For example, drugs can help reduce ataxia if Parkinson's disease is the cause. Antibiotics may be needed for an infection. Surgery may remove a brain tumour. If a stroke is the cause, the only treatment may be physiotherapy to improve function as much as possible.

What are the side effects of the treatments?
All medications have possible side effects. These may include allergic reactions, stomach upset, and headaches. Particular side effects depend on the medicatiions used. Any surgery carries a risk of bleeding, infection, and reactions to any pain medications used. Specific side effects depend on the surgery being done.

What happens after treatment for the condition?
Treatment may be short-term or lifelong. Those who drank too much alcohol may need no further treatment once the alcohol leaves their system.

How is the condition monitored?
Monitoring depends on the underlying cause. Those with diabetes or AIDS often need close monitoring with frequent visits to the doctor and blood tests. People whose infections are treated may need no further monitoring after they recover.

Author: Adam Brochert, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Contributors
Potential conflict of interest information for reviewers available on request


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