General Management Goals

Acquired ataxias need to be treated according to the primary disorder. However, ataxia is often associated with progressive degenerative disease, and it is rarely possible to influence the underlying cause. Only a few forms of inherited ataxias can be treated effectively, such as episodic ataxias using acetazolamide. In most cases, no pharmacological treatment is known. The pharmacological trials using various drugs--GABA agonists (baclofen, sodium valproate), choline chloride, lecithin, physostigmine, gamma-vinyl gamma-aminobutyric acid, thyrotropin-releasing hormone, and 5-hydroxytryptophan--have been disappointing. Other drugs, like buspirone, amantadine, and a combination of sulfamethoxazole and trimethoprim, are still being investigated in clinical trials. Physical therapy is the most important treatment of disorders of coordination and ataxia. Dyssynergia might be reduced by placing additional weight on an ataxic limb to increase inertia. Genetic testing is available in an increasing number of hereditary cerebellar ataxias. However, genetic counseling has to be carefully approached because hereditary cerebellar ataxias are not treatable. Genetic counseling should agree with the guidelines for predictive and prenatal DNA analysis published by the International Huntington's Association and the World Federation of Neurologists. Drugs such as lithium and phenytoin, which are associated with cerebellar dysfunction, should be avoided. Additional neurological symptoms, like spasticity, and physical signs, like diabetes, heart disease, and skeletal deformity, are treated in a common fashion.

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