Ataxia is a motor disorder not accompanied by paralysis, the characteristic features of which are rhythm disorders and coordination of movements. Translated from the Greek word ataxia means "randomness" and "randomness".
With this diagnosis, the movements become disproportionate, awkward, inaccurate, walking often suffers, and in some cases even speech. Consider which types of ataxia are distinguished, and what are their characteristic features.
Ataxia Friedreich
Friedreich's hereditary ataxia is a genetically determined neurological disease that is progressive in nature. The initial manifestations of the disease become noticeable in the first few decades of life.
First, there are violations of handwriting and gait. For children, however, it is difficult to detect a violation of handwriting in view of the fact that it has not yet fully formed. As for gait, the patient in this case needs support, he constantly sways. All leg movements are more jerky than progressive.
Over time, the inability to stand (astasia) and even walk (abasia) develops. However, the latter is a characteristic manifestation of the rapidly progressing course of the disease and its last stages.
Changes in the spine are observed, which is especially true for adolescents in whom the process of its formation is not yet complete. After a few years, the patient develops diabetes due to malfunctions of the pancreas. A little later, due to degenerative changes in the gonads, hypogonadism occurs. In the last stages of ataxia, visual impairment arises as a result of dystrophic changes in the optic and oculomotor nerves. On top of that, dementia develops due to damage to brain neurons.
Cerebellar lesion
Cerebellar ataxia is a disorder of motor coordination that develops when the main organ responsible for it is damaged - the cerebellum of the brain. In some cases, minor changes develop, and in others - more serious and severe.
The development of such ataxia occurs due to the involvement of various areas of the cerebellum by a pathological process. Often, cerebellar ataxia is diagnosed with encephalitis, cerebrovascular disease, multiple sclerosis, malignant brain tumors, intoxications, as well as certain ailments of a genetic origin. There are 2 types of cerebellar ataxia - static and dynamic.
The static nature of cerebellar ataxia
The defeat of the cerebellum is expressed in static ataxia due to a decrease in muscle tone. In the process of this, it becomes difficult for the patient to stay in one position for a long time, and he also has a slight violation of motor coordination. A man moves with very broad and staggering steps, as if in a state of intoxication. In the case of a severe course of the disease, the patient is not able to sit and stand on his own, because, not having the strength to even hold his head, he constantly falls. Severe static ataxia deprives the patient of the ability to independently maintain balance. It should be noted that motor coordination is not affected by whether the patient is with his eyes open or closed.
The dynamic nature of cerebellar ataxia
Dynamic ataxia develops when cerebellar hemispheres are involved in the pathological process. With this type of disease, coordination disorders are observed exclusively with physical movement. The smoothness and accuracy of the movements are lost, they become sweeping and awkward. Discoordination and slowdown are observed on the affected side. Dynamic ataxia is characterized by hypermetry (excessiveness, opposite movements), adiadhokinesis, oversight, as well as intentional tremor and speech disorders (patients speak slowly, breaking words into syllables).
In a standing position and when walking, the patient deviates to the side corresponding to the damaged cerebral hemisphere. The patient’s handwriting is changing: it becomes uneven, sweeping, with large letters. A decrease in tendon reflexes is not ruled out.
Sensory ataxia
This ataxia is a movement disorder in which gait changes due to loss of sensation in the legs resulting from damage to peripheral nerves, the medial loop, posterior pillars or posterior roots of the spinal cord. The patient does not feel the position of the legs, and therefore has difficulty both walking and standing. As a rule, he stands with his legs wide apart and at the same time can maintain balance only with his eyes open, if you close them, then the person will begin to stagger and, most likely, will fall (positive Romberg symptom). When walking, patients also widely spread their legs and lift them much higher than necessary, as well as impetuously swaying forward and backward. Their steps have different lengths, and the feet, touching the floor, make clapping sounds. The patient, when walking, usually uses a stick for support and bends the trunk somewhat in the hip joints. Gait disturbances exacerbate visual defects. Often patients lose stability, sway and fall when washing, because by closing their eyes they temporarily lose visual control.
Spinocerebellar ataxia
This term refers to many motor disorders that occur mainly due to ischemic damage to the central nervous system in the perinatal period or hypoxia. The severity of gait changes can be different and depends on the severity and nature of the lesion. So, limited lung lesions can cause a Babinsky symptom, an increase in tendon reflexes and not be accompanied by a pronounced change in gait. Extensive and more pronounced lesions usually entail bilateral hemiparesis. There are changes in gait and posture characteristic of paraparesis.
Cerebral palsy causes motor disorders that entail a change in gait. In this case, patients experience involuntary movements in the limbs, which are accompanied by grimaces on the face or rotational movements of the neck. As a rule, the legs are extended, and the arms are bent, however, this asymmetry of the limbs can become noticeable only with careful observation of the patient. For example, one arm can be pierced and extended, and the other supinated and bent. The asymmetric position of the limbs often occurs when turning the head in different directions.
Ataxia Diagnosis
To establish a diagnosis, such diagnostic methods are used as:
- MRI of the brain;
- brain electroencephalography;
- DNA diagnostics;
- electromyography.
In addition to any of the indicated methods, it is necessary to take a blood test, to be examined by specialists such as a neurologist, psychiatrist and optometrist.
Ataxia treatment
Ataxia is a serious disease that requires timely action. The treatment, which is carried out by a specialist neurologist, is mainly symptomatic and includes the following areas.
- General strengthening therapy (anticholinesterase agents, “Cerebrolysin”, ATP, B vitamins).
- Physiotherapy aimed at preventing various kinds of complications (muscle atrophy and contracture, for example), improving walking and coordination, maintaining physical fitness.
A special gymnastic complex of exercise therapy exercises, the purpose of which is to reduce discoordination and strengthen muscles. With a radical method of treatment (surgery of cerebellar tumors, for example), partial or complete recovery, or at least the cessation of further progression, can be expected.
With Friedreich's ataxia, taking into account the pathogenesis of the disease, drugs aimed at maintaining the functions of mitochondria (Riboflavin, vitamin E, coenzyme Q10, succinic acid) can play a huge role.
Disease prognosis
The prognosis of hereditary diseases is rather unfavorable. Over time, especially with inaction, neuropsychiatric disorders only progress. People with a diagnosis of ataxia, whose symptoms become more pronounced with age, usually have a significantly reduced ability to work.
However, thanks to symptomatic treatment, as well as the prevention of intoxication, trauma and infectious diseases, patients live to old age.
Prevention
It is impossible to carry out preventive measures specifically for ataxia. First of all, it is required to prevent the possible appearance and development of acute infectious diseases (sinusitis, otitis media, pneumonia, for example) that can provoke ataxia.
Blood marriages must be avoided. In addition, it should be remembered that the probability of transmission of hereditary ataxia from parent to child is high, and therefore patients are often recommended to abandon the birth of their own babies and adopt another person's child.
Ataxia is a serious neurological disorder that needs to be treated immediately. That is why the earlier this ailment was identified, the more favorable the prognosis will be for the patient.