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Ataxia and MS

Medically Reviewed by Christopher Melinosky, MD on April 15, 2022

Ataxia is loss of muscle control in your arms and legs. Ataxia may cause you to lose your balance and walk with an unsteady gait. You may feel dizzy, clumsy, or unable to coordinate and control your movements.

Ataxia can affect your control over your eye movements and the muscles that you use to walk, sit up, stand, speak, or swallow. Your limbs and muscles may twitch or shake when you try to do ordinary tasks at home or at work.

Ataxia can cause you to lose your balance when you stand or try to walk across a room. Other people may think you’re staggering because you’re drunk. These symptoms can cause you embarrassment.

Who Gets Ataxia?

Ataxia is a common symptom of multiple sclerosis (MS) that affects about 80% of people with the disease. If you have primary progressive or secondary progressive MS, you may be more likely to develop ataxia at some point.

Many people with MS have only mild ataxia symptoms. Tremors and loss of coordination don’t affect their daily activities very much. There are also treatments, including rehabilitation exercises, to help you manage ataxia with MS.

What Causes Ataxia in MS?

Even though you have tremors or lack of muscle control with ataxia, it’s not caused by muscle weakness, but damaged motor and sensory nerves caused by MS.

In MS, inflammation attacks and damages nerve fibers and myelin, a protective tissue around the nerves in your brain and spinal cord. Eventually, nerve cells that control your movements by sending and receiving electrical signals are damaged. Nerves can’t communicate with each other normally to control your body movements.

Types of Ataxia

People with MS may have one or more of the three types of ataxia: cerebellar, sensory, and vestibular:

Cerebellar ataxia is caused by damage to your cerebellum in the back of your brain, above your brainstem and neck. The cerebellum is the size of a fist. Neurons inside your cerebellum control your voluntary muscle movements to help you stand, balance, and steady yourself.

MS inflammation can lead to lesions or scarred areas in your cerebellum or parts of your brain that are connected to the cerebellum. This can cause disruptions to the actions of different nerves that control muscle and movements on one or both sides of your body.

Cerebellar ataxia may cause you to lose coordination when you walk, stand, or move. You may have shaky eye or hand movements. You may not be able to maintain a steady posture or balance. Cerebellar ataxia may cause you to lose control of muscles that you use to speak, leading to slurred, slow, or abnormal speech. You may have less range of motion in your joints too.

Cerebellar ataxia damage may cause cognitive symptoms in some people with MS. You may not be able to organize your thoughts, make plans, or process new information as you once did. You may become moody, anxious, or depressed at times.

Sensory ataxia is also called proprioceptive ataxia. It’s a loss of sensitivity in the movement of your joints, limbs, and other body parts. Sensory ataxia is caused by damage to nerves in the dorsal column in the back of your spinal cord. These nerves carry messages to your brain that regulate how you position your body parts and limbs.

Sensory ataxia may also be caused by changes in parts of your brain where nerve messages are received, like your cerebellum, thalamus, and parietal lobe. Your brain confuses messages about proprioception, or how to position your body within a space when you move.

Sensory ataxia in MS causes you to have an unsteady walk. You may drive your heels into the floor when you walk, so it seems like you’re stomping.

At night or in dimly lit rooms, sensory ataxia symptoms may be worse because you can’t sense how far your feet are from the floor or how far your hands are from the back of a chair. You may develop Romberg’s sign, or an unsteady posture and loss of balance when your eyes are closed or it’s dark. Romberg’s sign can increase your risk of falling.

Vestibular ataxia is caused by damage to your vestibular system, such as your inner ear structures and fluid-filled ear canals that control your sense of balance. Vestibular ataxia may also happen if MS causes lesions on your brainstem or vestibular system parts, or if MS damages nerves that connect tiny organs in your inner ear that control balance.

Vestibular ataxia causes vertigo, loss of balance, dizziness, nausea, vomiting, and eye jitters or twitches. Some people with MS develop vestibular ataxia slowly, so they just have a loss of balance or equilibrium, not other severe symptoms.

How Can Ataxia Affect Your Daily Life?

Ataxia can make many ordinary daily tasks a real challenge. You may struggle to dress yourself, hold a fork, open a jar, or type on your computer keyboard or phone. As you lose motor coordination, you may not be able to play sports that you enjoy.

Personal safety issues. People with MS who have ataxia are more likely to fall down or trip. Uneven or unsteady surfaces are especially risky, like stairs, escalators, moving sidewalks at the airport, boats, or bridges.

Ataxia can cause vision problems. You may not be able to control your eye movements or focus, so it’s difficult to read. People with MS may develop blurred or double vision due to ataxia.

You may have trouble swallowing food, and even choke or gag when you drink a glass of water. Your speech may be slurred so other people can’t understand what you’re saying if you need help or directions.

Ataxia can cause severe fatigue for some people with MS. You have to exert more effort to make ordinary movements and focus your attention so you don’t hurt yourself. Normal activities can be exhausting.

Emotions and self-image. Living with ataxia can take an emotional toll. You may be embarrassed by your tremors or loss of balance. This can lower your self-image. You might even avoid social activities because you don’t want other people to see you shake, drop things, or struggle to walk.

You may start to feel limited in what activities or tasks you can manage without help from family or friends. You feel like you’ve lost your independence.

Ataxia Testing

Your doctor may perform a few simple tests to gauge the extent of your loss of muscle control and balance during basic movements.

  • While you’re in the exam room, they may ask you to walk in a straight line, placing one foot in front of the other, or touch your finger to their outstretched finger and then your nose. They may ask you to repeat motions with your eyes closed and open.
  • They can also test you for Romberg’s sign: With your eyes open, you’ll stand still with your feet as close together as possible, flat on the floor. Then, you’ll close your eyes to test your balance. Nerve or spinal cord damage from ataxia can cause you to wobble.

How Can You Treat and Manage Your Ataxia Symptoms?

Tremors are difficult to treat in MS. But a combination of treatments and adjustments to how you perform movements may help you manage ataxia.

Physical and occupational rehabilitation. A physical therapist (PT) can guide you to learn and perform a series of exercises to build strength and stability in your core muscles. These are the muscles in your trunk and pelvis, like your abdominals (abs), back muscles, and hip muscles. Ataxia often causes people with MS to develop weakness in these muscles, because your loss of balance encourages you to sit more than you walk or move around.

You may also work with an occupational therapist (OT) to learn how to manage fatigue or muscle shakiness that throws you off balance during ordinary tasks. Your OT can show you how to use assistive devices, like a weighted fork to eat dinner more easily with a hand tremor.

In rehab, your PT may suggest activities to help you improve balance and coordination, like yoga, tai chi, or playing with a balance board at home. These exercises and games can lift your spirits and may preserve your cognitive function with MS, too.

In rehab, you’ll also learn compensatory techniques to make ordinary movements or tasks easier for you:

  • Your PT may teach you exercises to react and adapt to loss of balance. They may train you to move through head and eye motions, walk without full vision or light, or shift your weight on an unsteady surface.
  • They may train you to take simple precautions to lower your risk of a fall, like how to hold a handrail or banister when you walk. In rehab, you may learn how to pause and rest during activities so you don’t wear yourself out or fall.
  • They can show you hacks to make motions easier, like wearing tightly fitted exercise clothes or weighted cuffs if ataxia affects your arms.

Mobility aids. Your physical therapist can prescribe a cane, brace, or walker for you and teach you how to use them properly. Mobility aids help people with MS move with more safety to reduce risk of falls.

Braces fitted to your ankles or feet may help you walk more steadily. Braces can also help you stabilize your arms, hands, or neck for more control of your movements.

Speech therapy. If you have tremors in the muscles around your mouth, your doctor can refer you to a speech therapist. They can work with you to speak more slowly and clearly, or help you control your volume when you talk.

Medications. Your doctor may prescribe one of these medications off-label that may relieve your tremors, although they may not be FDA-approved to treat MS tremors:

  • Buspirone (Buspar)
  • Clonazepam (Klonopin)
  • Gabapentin (Neurontin)
  • Hydroxyzine (Atarax, Vistaril)
  • Isoniazid (Laniazid, Nydrazid)
  • Ondansetron (Zofran)
  • Levetiracetam (Keppra)
  • Primidone (Mysoline)
  • Propranolol (Inderal)
  • Topiramate (Topamax, Trokendi XR, Qudexy XR)

Cannabis or medical marijuana has shown to improve tremors in some small studies, but more research needs to be done to see if this is an effective, safe treatment option for people with MS.

Show Sources

SOURCES:

Multiple Sclerosis Trust: “Ataxia.”

National Multiple Sclerosis Society: “Tremor.”

My-MS.org: “Coordination and Balance Symptoms.”

Frontiers in Neurology: “Cerebellar Dysfunction in Multiple Sclerosis.”

Johns Hopkins Medicine: “What Is Multiple Sclerosis (MS)?” “Brain Anatomy and How the Brain Works,” “Symptom of Ataxia,” “Vestibular Balance Disorder.”

Osmosis from Elsevier: “Posterior Cord Syndrome.”

Frontiers in Human Neuroscience: “Clinical Recognition of Sensory Ataxia and Cerebellar Ataxia.”

Mayo Clinic: “Core exercises: why you should strengthen your core muscles.”

Multiple Sclerosis Association of America: “Tremor.”

Clinical Neuropharmacology: “Successful treatment of cerebellar ataxia and tremor in multiple sclerosis with topiramate: a case report.”

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