Ataxia: A Symptom That Points to the Need for a Deeper Dive (Podcast)

“Ataxia is a clinical symptom that presents with incoordination as the primary motor symptom,” says Odinachi Oguh, MD. “It is an incoordination of gait, an incoordination of dexterity, movements in the upper extremity, and incoordination of speech.”

The most common form of ataxia is alcohol-induced — a form many are familiar with, adds Dr. Oguh. And anyone who knows that sensation has some insight into the movement difficulties experienced by someone with disease-related ataxia.

In the latest episode of Cleveland Clinic’s Neuro Pathways  podcast, Dr. Oguh, a fellowship-trained movement disorders neurologist at Cleveland Clinic, Nevada, discusses with podcast host Glen Stevens, DO, the wide variety of rare and common ataxias and how they show up in the clinical environment.

Differentiating ataxia from another movement disorder, for example, requires the clinician to observe the patient’s gait. Dr. Oguh sometimes sees patients who have come in with a referral for ataxia, but what they have is vestibular symptoms.

“The key finding in ataxia is that you do want to see both upper and lower body symptoms,” she explains. “Typically, their gait is wide-based, and wide-based gait is usually a non-tandem gait.”

The podcast conversation also touches on these topics, among others:

• Ataxia as a part of a paraneoplastic syndrome
• Friedreich's ataxia
• MS-related ataxia
• Autosomal dominant spinocerebellar ataxia

Click the podcast player above to listen to the 30-minute episode now or read on for an excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Podcast Excerpt

Glen Stevens, DO, PhD: Can you go through some of the groups of disorders that cause ataxia? 

Odinachi Oguh, MD: Causes of ataxia can be vast, so I tend to break it down into what I call symptomatic ataxias.

Paraneoplastic ataxias are autoimmune disorders that are sometimes triggered by some form of neoplastic process, but it's not always the case that a neoplastic process triggers it. But typically, these are what we call a much more subacute onset of ataxia.

Then you do have the most common [ataxias], which we see in acute strokes, in cerebellar strokes.

Other types of ataxias [can be] much more chronic, much more slowly progressive, and happen over decades and years. We are talking about either the autosomal dominant or autosomal recessive ataxias, and we often forget the mitochondrial ataxias as well. So those certainly fall under some of the genetic or inherited ataxias.

Then you have the neurodegenerative ataxias. Those typically come under the diseases that I call sisters or cousins of Parkinson's, like multiple system atrophy, where you have a cerebellar subtype, and oftentimes you can have a host of parkinsonism and cerebellar symptoms in the same patient.

That makes up the most common form of neurodegenerative ataxias. Then you have those for which we don't know what the answer is, which is idiopathic or sporadic ataxias. There's a lot of data now looking at idiopathic ataxias, and perhaps 50% of those patients turn out to be neurodegenerative ataxias like [multiple system atrophy]. 

So again, this is a simplistic classification, but it gives you an overview of what ataxia is and the various etiological causes of ataxia.