In this review, we present the multidisciplinary approach to the management of the many neurological, medical, social, and emotional issues facing patients with
cerebellar ataxia.
RECENT FINDINGS: Our holistic approach to treatment, developed over the past 25 years in the Massachusetts General Hospital
Ataxia Unit, is centered on the compassionate care of the patient and their family, empowering them through engagement, and including the families as partners in the healing process. We present the management of
ataxia in adults, beginning with establishing an accurate diagnosis, followed by treatment of the multiple symptoms seen in
cerebellar disorders, with a view to maximizing quality of life and effectively living with the consequences of
ataxia. We discuss the importance of a multidisciplinary approach to the management of
ataxia, including medical and non-medical management and the evidence base that supports these interventions. We address the pharmacological treatment of
ataxia,
tremor, and other associated
movement disorders; ophthalmological symptoms; bowel, bladder, and sexual symptoms;
orthostatic hypotension; psychiatric and
cognitive symptoms; neuromodulation, including
deep brain stimulation; rehabilitation including
physical therapy,
occupational therapy and speech and language pathology and, as necessary, involving urology, psychiatry, and
pain medicine. We discuss the role of
palliative care in late-stage disease. The management of adults with
ataxia is complex and a team-based approach is essential.