An Overview of Dysdiadochokinesia in Multiple Sclerosis

This collection of MS-related symptoms can affect balance and speech

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A neurologist examines a brain scan.
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Dysdiadochokinesia (DDK), a constellation of symptoms in people with multiple sclerosis (MS), refers to the inability to perform rapid, alternating movements, such as flipping one's hand from back to front on a flat surface, or screwing in a light bulb. DDK can also cause problems with balance, walking, eye movements, and speech.


DDK typically affects the muscles in the arms, hands, legs, and feet, as well as the muscles in the larynx that control speech. Symptoms of dysdiadochokinesia fit within a category of neurological problems known as ataxia and include:

  • Problems with balance and walking, including slowness, or awkward or rigid movements
  • Poor coordination of the arms, hands, or legs
  • Inarticulate or incomprehensible speech, and difficulties with swallowing
  • Difficulty stopping one movement and starting another in the opposite direction
  • Tremors, weakness, spasticity, inability to move the eyes, and loss of sensitivity in the hands and feet

Another neurological sign that may appear in people with MS is called dysmetria, which refers to a person's inability to judge distance.


It's believed that dysdiadochokinesia is caused by MS lesions in the cerebellum, a part of the brain that controls voluntary muscle movements, posture, and balance. Damage to fibers in the central nervous system can result in hypotonia, or muscle weakness, which can contribute to the problem.

Dysdiadochokinesia is also associated with a gene mutation that affects neurotransmitters—the chemicals that communicate information throughout our brain and body.


Typically, a neurologist will perform tests that lead to a diagnosis of dysdiadochokinesia. These tests include:

  • Having the patient alternately flip each hand from palm side up to palm side down as quickly as possible on a stable surface like a table
  • Asking the patient to demonstrate the movement of turning a doorknob or screwing in a lightbulb
  • A point-to point movement evaluation, in which the patient is asked to touch his nose, and then, using the same finger and as quickly as possible, touch the outstretched finger of the person doing the test
  • Heel shin test: The patient places one heel on one shin just below the knee, and then slides the heel down the shin to the foot.
  • Romberg test: The patient is asked to stand still with his heels together and eyes closed.
  • Gait test: The patient is asked to walk normally and then walk heel-to-toe.

A person with dysdiadochokinesia will be unable to perform the above tests in a correct and coordinated fashion. Their movements may be slowed, unusual, or clumsy.


Treating dysdiadochokinesia and cerebellar ataxia, in general, is challenging, and there are no specific strategies that are scientifically supported at this time.

Sometimes medications used to treat tremor, such as Neurontin (gabapentin) and Topamax (topiramate) are used to treat ataxia, and at times, surgery may be considered.

A 2014 study in the Journal of Neurology found that physical therapy and occupational therapy may provide some benefit. Strength training, balance exercises, treadmill walking and exercises to improve core strength may all be helpful; speech therapy may also be necessary.

Learning strategies for how to prevent falls and modifying the home (for example, installing grab rails, removing loose carpets, and placing nonskid mats) can keep someone safe if they continue to struggle with symptoms of DDK.

A Word From Verywell

Living with dysdiadochokinesia can be frightening and unsettling. While there is no known “cure” for DDT, seeking out medical advice and working with physical and occupational therapists can help you keep symptoms down to a manageable level.

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