Multiple sclerosis (MS) is a disease that damages the nerves of the central nervous system. This damage disrupts nerve impulses and can lead to ataxia — a condition that affects coordination, balance, and speech.
This article outlines the symptoms of ataxia.
It also considers the prevalence of this condition among individuals with MS.
We further outline the cause of MS-induced ataxia and list some treatment and management options.
According to the American Brain Foundation, early signs of ataxia typically include impairments in balance and coordination. This loss of muscle control may lead to the following:
- slurred speech
- abnormal posture
- wide, staggering gait
- difficulty walking
- tremors
- difficulty performing fine motor skills
- problems with speaking
- problems with eating
- difficulty moving the following body parts:
- fingers
- hands
- arms
- legs
- eyes
Experts estimate that around 8 in 10 people with MS will experience some degree of ataxia during their illness. For most, the symptoms will be relatively mild and will not have a major impact on their day-to-day life.
The National Multiple Sclerosis Society explains that MS is an autoimmune condition in which the body’s immune system attacks and damages the protective myelin sheath surrounding the nerves of the central nervous system (CNS). This damage impairs the ability of the nerves to transmit information.
Muscle coordination involves a complex interplay of messages from different parts of the body, including:
- a part of the brain known as the cerebellum, which coordinates the timing and force of muscle movements
- the vestibular system in the inner ear, which detects the position and movement of the head in space to help coordinate movement and balance
- the eyes, which integrate visual information to help guide movement
In MS, nerve damage affecting any of the above can disrupt balance and muscle coordination, resulting in ataxia.
The United Kingdom’s National Health Service (NHS) provides the following tips for treating and managing ataxia symptoms:
Physical therapy
People with MS-induced ataxia may spend a lot of time sitting because of balance issues. However, long periods of inactivity can weaken the core muscles and other muscle groups, ultimately worsening balance and stability. A physical therapist can devise a set of exercises to help a person develop core strength.
A physical therapist can also work with a person to identify tasks they find difficult and devise strategies to make those tasks more manageable. Some strategies they may recommend include:
- Wearing weighted cuffs: These are cuffs a person can wear on their wrists to help reduce the effects of arm tremors.
- Wearing tight-fitting clothing: Tight-fitting clothing such as Lycra increases pressure on the body, which can help with proprioception — awareness of the body’s position in space. This may help improve posture and control over body movements.
- Using walking aids: These can help people with balance issues to remain mobile while reducing the risk of falls.
Read more about physical therapy.
Speech and language therapy
A speech and language therapist can provide exercises and techniques to help a person overcome common ataxia issues, such as slurred speech and swallowing difficulties. They may recommend the following:
- breathing techniques to improve speech
- exercises to strengthen the muscles a person uses for speech
- speaking more slowly to emphasize individual words
- postural changes to improve vocal quality
- speaking aids if speech difficulties worsen
- exercises to stimulate the swallowing reflex and strengthen the muscles a person uses for swallowing
Medications
Doctors may recommend medications to help manage certain ataxia symptoms. Examples include:
- Muscle relaxants: These can help to alleviate muscle spasms, cramps, and stiffness. Examples include:
- baclofen
- tizanidine
- Botulinum toxin (Botox) injections
- Prescription pain relievers: Damage to the nerve endings can cause nerve pain, or “neuropathic pain.” This type of pain often does not respond to treatment with over-the-counter pain relievers, such as acetaminophen or ibuprofen. Instead, doctors may prescribe prescription pain relievers, such as:
Multiple sclerosis is an autoimmune disease that damages the protective myelin sheaths surrounding the nerves of the central nervous system. Over time, this damage impairs the ability of the nerves to transmit information. Damage to the nerves involved in muscle coordination and balance can result in ataxia.
Symptoms of ataxia may include abnormal posture and gait, slurred speech, and difficulty performing fine motor skills. Physiotherapy can help with certain ataxia symptoms, such as postural problems, balance issues, and tremors. Speech and language therapy can help with issues such as slurred speech and swallowing difficulties.
Doctors may also recommend medications to help with certain ataxia symptoms. Examples include muscle relaxants for muscle spasms and stiffness, and pain relievers for neuropathic pain that often accompanies ataxia. A person can talk with their doctor for more advice about their individual treatment options.