What Is Ataxia?

Ataxia is the term used to describe the loss of coordination in the body. This loss of coordination can manifest as a loss of balance, slurred speech, stumbling, a wide gait, or a variety of other symptoms.

Ataxia can be a symptom of an underlying disease, such as multiple sclerosis, or it can be the cause itself. While ataxia is used most often to describe certain symptoms like loss of balance, it also describes a group of degenerative diseases of the central nervous system.

What Is Ataxia?

Ataxia can either refer to the symptom of loss of coordination, or it can refer to hereditary or sporadic ataxias.

In hereditary ataxias, you are born with a gene mutation that affects coordination in a degenerative manner. Your symptoms may appear in childhood or develop later in life and will progress over time. The severity of the disability is dependent on a number of factors, such as the age of onset and the type of ataxia.

In sporadic ataxia, there is no family history of the disease and symptoms usually begin in adulthood.

When ataxia is used to describe the loss of coordination that occurs due to an underlying cause, the symptoms can vary from slurred speech to loss of balance to stumbling and falling.

These symptoms affect your balance and the way you walk, talk, and move through your daily life.

Ataxia Symptoms

The symptoms of ataxia vary based on the cause. If the cause is an underlying disease or disease process, such as a stroke, tumor, alcoholism, or nerve damage, you may experience symptoms such as:

• Poor coordination
• Balance problems
• Inability to coordinate hands, arms, and legs
• Slurred speech
• A wide-based gait
• Difficulty writing and eating
• Slow eye movements

Symptoms from a genetic form of ataxia or sporadic ataxia can include:

• Poor coordination and balance
• Slurred speech
• Tiny, red spider veins on the skin and eyes
• Lung infections
• Delayed physical and sexual development
• Difficulty swallowing
• Tremors (involuntary shaking movements)
• Heart problems
• Difficulty walking

Ataxia Causes

Ataxia is more commonly a symptom of another disease process. If you experience loss of coordination or any of the other symptoms mentioned above, it’s important to talk to your healthcare provider to determine the cause.

Loss of coordination, slurred speech, and gait problems can all be caused by a variety of things. These causes include:

• Stroke and other brain injuries that result in a lack of oxygen to the brain
• Demyelinating diseases affecting the coating of nerves, like multiple sclerosis
• Exposure to heavy metals such as lead and mercury
• Alcohol use disorder (excessive use of alcohol) leading to problems in the cerebellum, the part of the brain responsible for coordinating voluntary movements
• Medications like those used in chemotherapy and those used to treat epilepsy
• Infectious diseases like encephalitis, HIV, and Whipple’s disease
• Autoimmune diseases like celiac disease
• Vitamin deficiencies including B12
• Hereditary causes including Friedreich ataxia, ataxia-telangiectasia, spinocerebellar ataxia, and Marinesco-Sjogren syndrome, among others

Types of Ataxia

There are three main categories of ataxia based on the part of the body that is affected. These are sensory, cerebellar, and vestibular ataxias:

• Sensory ataxia: This type is caused by damage to the somatosensory nervous system. Sensory feedback signals such as sight and sound are disrupted, making it difficult to maintain coordination.
• Cerebellar ataxia: When damage occurs to the cerebellum—the part of the brain that controls coordination—symptoms of ataxia will occur.
• Vestibular ataxia: When the vestibular system, which is the inner ear and cochlea, are affected, you can get symptoms such as vertigo (dizziness or a spinning sensation), nausea, and difficulty walking in a straight line.

All three of these categories will have different ataxia symptoms. Healthcare providers will often use specific clinical terms to describe the types of ataxia and how they affect your body.

Symptom Types of Ataxia

Based on your symptoms, your healthcare provider may use any of the terms below to talk about your condition and help determine a cause:

• Stance: With ataxia that affects your stance, it is difficult to stand with your feet together for more than 30 seconds.
• Gait ataxia: Loss of coordination in the legs and/or proprioceptive input, or understanding where your body is in space, can cause you to feel like you need to hold onto something as you walk. You may also walk with your feet wide apart to compensate for the feeling of falling. If you have a sensory or vestibular disturbance, you may also have difficulty walking when your eyes are closed or it’s dark outside.
• Sensory ataxia: You may walk with a high step or slap your feet on the ground to help you receive feedback on where you’re walking. When the upper limbs are affected with sensory ataxia, if you close your eyes while doing a task, your fingers may move in random patterns.
• Truncal ataxia: When sitting or standing, your upper body might move unsteadily, making you appear intoxicated.
• Limb ataxia: Often affecting the arms and hands, this can cause difficulty writing, picking up small objects, or buttoning clothes. It can also affect the legs.
• Dysdiadochokinesia/dysrhythmokinesis: A healthcare provider may have you tap your index finger to the pad of your thumb in a repeated pattern. If you have dysdiadochokinesia/dysrhythmokinesis, the pattern will be irregular in rhythm and amplitude (the size of the motion).
• Intention tremor: When you place your finger to your nose or heel to shin, you may find that your hand or foot starts to shake or tremor; this is an intention tremor. It specifically occurs when you are initiating the movement.
• Dysmetria: This ataxia occurs when you are trying to reach or touch an object and you overshoot or undershoot it.
• Dysarthria: This ataxia is often referred to as slurred speech. You may also talk irregularly or slowly with hesitation. You may break words down into separate syllables and put emphasis on consonants that aren’t usually emphasized.
• Nystagmus: This is a rhythmic side-to-side motion or up-and-down motion of the eyes, even when you’re trying to focus on something.
• Saccades: With saccades, your eyes move rapidly back and forth to try and find what you are looking at. This is actually normal during certain eye motions to quickly jump visually between objects. If saccades are impaired, you may see overshooting or undershooting a target, with corrective saccades to center the visual object.
• Square wave jerks/ocular flutter/opsoclonus: These are other disturbances in the eye movements where the eye may move in a fluttering or jerking manner.

Diagnosis

To diagnose ataxia, your healthcare provider will take a full medical history. They will go over your symptoms and conduct a physical exam looking for any of the ataxias mentioned above.

You may be asked to walk in a straight line, tap the pads of your index and thumb fingers together repeatedly, bring your pointer finger to touch your nose, or stand with your feet together and your eyes closed. These tests, along with others, can be conducted and observed in your practitioner’s office.

After conducting these tests and reviewing your history, your healthcare provider may then order other tests that they deem necessary. While your primary doctor can conduct many of these tests, you may also be referred to a neurologist for a more indepth workup.

Further testing for ataxia can include, but is not limited to:

• Magnetic resonance imaging (MRI): An MRI of the brain is almost always ordered with symptoms of ataxia. While this test won’t always identify an underlying condition, it can provide clues to your practitioner as to what is causing your ataxia.
• Blood tests: Your healthcare provider may also take blood to test your thyroid function, B12 and folate levels, and to see if you have celiac disease. These can help pinpoint the cause of your ataxia.
• Muscle biopsy: A muscle biopsy takes a sample of muscle tissue to be analyzed in the lab. It can help determine various causes of ataxia such as reduced CoQ10 levels and genetic mutations.
• Spinal tap: A spinal tap, or lumbar puncture, may be necessary to test the cerebrospinal fluid for any abnormalities.
• Further scans and blood tests: More tests may be necessary if cancer is suspected but undetected.
• Genetic testing: This type of testing can help determine if your ataxia is caused by one of the inherited forms of ataxia.

Treatment

Treatment for ataxia depends on the cause. If ataxia is a symptom of another disease, then the underlying disease will need to be treated. Treatment of the underlying disease or disease process can help relieve the symptoms or make them milder.

For example, you may be prescribed physical therapy after a stroke, given assistive devices for multiple sclerosis, or told to take vitamin supplements in the case of a vitamin deficiency. If you have celiac disease, then you will be coached on changing your diet to eliminate gluten.

All of the treatments for ataxia are dependent on the specific cause of your ataxia. Sometimes you will need to see a specialist who treats the disease causing your symptoms.

If your ataxia is part of the group of degenerative disorders, then your treatment options can include, but are not limited to:

• Medications: Riluzole, varenicline, and amantadine are all drugs that have shown some promise in improving gait and tremors.
• Occupational/physical therapy: Physical and occupational therapy that works on balance, gait, or control of movement can help improve quality of life with ataxia.

Summary

Ataxia is a loss of coordination, a symptom seen in multiple sclerosis, stroke, alcohol use disorder, and more. It also is a name given to a group of diseases that cause degeneration of the central nervous system. People with ataxia may show a loss of balance, slurred speech, stumbling, and unusual eye movements.

Your healthcare provider may be able to diagnose your condition or could refer you to a neurologist. Once the underlying condition is identified, treating it may address the ataxia.

A Word From Verywell

Since treatment for ataxia is dependent on the cause, if you experience any symptoms of ataxia, you should contact your healthcare provider immediately for a full examination. Do not be afraid to ask for help. Learning the cause of your ataxia can help maintain your quality of life.  

Once a cause is determined, you can begin treatment. While there may not be a cure for your symptoms, often just knowing the cause can help you find more information about your disease and learn to cope.