Abstract
Diseases involving the cerebellum occur relatively commonly in children and adults around the globe. Many factors influence their epidemiology including geography, ethnicity, consanguinity, and the methodology used to ascertain patients. In addition, reliable epidemiological data rely heavily on accurate disease classification. Continuous advances in genetic research and neuroimaging modalities have resulted in improved understanding of cerebellar diseases and have led to several revisions in their classification. Recent global epidemiological studies on ataxia reported an estimated overall prevalence rate of 26/100,000 in children, a prevalence rate of dominant hereditary cerebellar ataxia of 2.7/100,000, and a prevalence rate of recessive hereditary cerebellar ataxia of 3.3/100,000. The management of cerebellar diseases is multidisciplinary and multimodal. General supportive and symptomatic therapies should be initiated. Genetic counseling should be offered, where appropriate. Few drugs, specific motor rehabilitation programs, and noninvasive cerebellar stimulation for the treatment of ataxia have been developed and seem to show early promise, but more studies are needed to replicate and fine-tune their benefits further. Some disease-specific treatments are available. For example, acetazolamide or 4-aminopyridine for patients with episodic ataxia type 2 and vitamin E for patients with ataxia caused by vitamin E deficiency.
This is a preview of subscription content, access via your institution.
References
Pandolfo M, Manto M. Cerebellar and afferent ataxias. Continuum (Minneap Minn). 2013;19(5):1312–43.
Boltshauser E. Cerebellum-small brain but large confusion: a review of selected cerebellar malformations and disruptions. Am J Med Genet A. 2004;126:376–85.
Salman MS, Lee EJ, Tjahjadi A, Chodirker BN. The epidemiology of intermittent and chronic ataxia in children in ManitobaCanada. Dev Med Child Neurol. 2013;55(4):341–7.
Musselman KE, Stoyanov CT, Marasigan R, Jenkins ME, Konczak J, Morton SM, et al. Prevalence of ataxia in children: a systematic review. Neurology. 2014;82(1):80–9.
Bernard G, Shevell M. The wobbly child: an approach to inherited ataxias. Semin Pediatr Neurol. 2008;15(4):194–208.
Sequeiros J, Martins S, Silveira I. Epidemiology and population genetics of degenerative ataxias. Handb Clin Neurol. 2012;103:227–51.
Ruano L, Melo C, Silva MC, Coutinho P. The global epidemiology of hereditary ataxia and spastic paraplegia: a systematic review of prevalence studies. Neuroepidemiology. 2014;42(3):174–83.
Infante J, Combarros O, Volpini V, Corral J, Llorca J, Berciano J. Autosomal dominant cerebellar ataxias in Spain: molecular and clinical correlations, prevalence estimation and survival analysis. Acta Neurol Scand. 2005;111(6):391–9.
Tsuji S, Onodera O, Goto J, Nishizawa M. Study Group on Ataxic Diseases. Sporadic ataxias in Japan-a population-based epidemiological study. Cerebellum. 2008;7(2):189–97.
Anheim M, Fleury M, Monga B, Laugel V, Chaigne D, Rodier G, et al. Epidemiological, clinical, paraclinical and molecular study of a cohort of 102 patients affected with autosomal recessive progressive cerebellar ataxia from Alsace, Eastern France: implications for clinical management. Neurogenetics. 2010;11(1):1–12.
Silva MC, Coutinho P, Pinheiro CD, Neves JM, Serrano P. Hereditary ataxias and spastic paraplegias: methodological aspects of a prevalence study in Portugal. J Clin Epidemiol. 1997;50:1377–84.
Wedding IM, Kroken M, Henriksen SP, Selmer KK, Fiskerstrand T, Knappskog PM, et al. Friedreich ataxia in Norway - an epidemiological, molecular and clinical study. Orphanet J Rare Dis. 2015;10:108.
Himmelmann K, Hagberg G, Uvebrant P. The changing panorama of cerebral palsy in Sweden. X. Prevalence and origin in the birth-year period 1999-2002. Acta Pediatrica. 2010;99:1337–43.
Esscher E, Flodmark O, Hagberg G, Hagberg B. Non-progressive ataxia: origins, brain pathology and impairments in 78 Swedish children. Dev Med Child Neurol. 1996;38:285–96.
Oiglane-Shlik E, Talvik T, Zordania R, Põder H, Kahre T, Raukas E, et al. Prevalence of Angelman syndrome and Prader-Willi syndrome in Estonian children: sister syndromes not equally represented. Am J Med Genet A. 2006;140:1936–43.
Erichsen AK, Koht J, Stray-Pedersen A, Abdelnoor M, Tallaksen CM. Prevalence of hereditary ataxia and spastic paraplegia in southeast Norway: a population-based study. Brain. 2009;132:1577–88.
Salman MS, Masood S, Azad M, Chodirker BN. Ethnicity and geographic distribution of pediatric chronic ataxia in Manitoba. Can J Neurol Sci. 2014;41:29–36.
Salman MS, Klassen SF, Johnston JL. Recurrent ataxia in children and adolescents. Can J Neurol Sci. 2017;44(4):375–383.
Fekete R. Ataxia. In: Jankovic J, editor, Greenamyre JT, editor-in-chief. MedLink Neurology. San Diego: MedLink Corporation. Available at https://www.medlink.com. Last updated: 28th October 2015.
Ilg W, Bastian AJ, Boesch S, Burciu RG, Celnik P, Claaßen J, et al. Consensus paper: management of degenerative cerebellar disorders. Cerebellum. 2014;13(2):248–68.
Kearney M, Orrell RW, Fahey M, Brassington R, Pandolfo M. Pharmacological treatments for Friedreich ataxia. Cochrane Database Syst Rev. 2016;8:CD007791.
Ristori G, Romano S, Visconti A, Cannoni S, Spadaro M, Frontali M, et al. Riluzole in cerebellar ataxia: a randomized, double-blind, placebo-controlled pilot trial. Neurology. 2010;74(10):839–45.
Romano S, Coarelli G, Marcotulli C, Leonardi L, Piccolo F, Spadaro M, et al. Riluzole in patients with hereditary cerebellar ataxia: a randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2015;14(10):985–91.
Vogel AP, Folker J, Poole ML. Treatment for speech disorder in Friedreich ataxia and other hereditary ataxia syndromes. Cochrane Database Syst Rev. 2014;10:CD008953.
Ilg W, Synofzik M, Brötz D, Burkard S, Giese MA, Schöls L. Intensive coordinative training improves motor performance in degenerative cerebellar disease. Neurology. 2009;73(22):1823–30.
Ilg W, Brötz D, Burkard S, Giese MA, Schöls L, Synofzik M. Long-term effects of coordinative training in degenerative cerebellar disease. Mov Disord. 2010;25(13):2239–46.
Miyai I, Ito M, Hattori N, Mihara M, Hatakenaka M, Yagura H, et al. Cerebellar Ataxia Rehabilitation Trialists Collaboration. Cerebellar ataxia rehabilitation trial in degenerative cerebellar diseases. Neurorehabil Neural Repair. 2012;26(5):515–22.
Keller JL, Bastian AJ. A home balance exercise program improves walking in people with cerebellar ataxia. Neurorehabil Neural Repair. 2014;28(8):770–8.
Ilg W, Schatton C, Schicks J, Giese MA, Schöls L, Synofzik M. Video game-based coordinative training improves ataxia in children with degenerative ataxia. Neurology. 2012;79(20):2056–60.
Shiga Y, Tsuda T, Itoyama Y, Shimizu H, Miyazawa KI, Jin K, et al. Transcranial magnetic stimulation alleviates truncal ataxia in spinocerebellar degeneration. J Neurol Neurosurg Psychiatry. 2002;72(1):124–6.
Grimaldi G, Oulad Ben Taib N, Manto M, Bodranghien F. Marked reduction of cerebellar deficits in upper limbs following transcranial cerebello-cerebral DC stimulation: tremor reduction and re-programming of the timing of antagonist commands. Front Syst Neurosci. 2014;8:9.
Grimaldi G, Argyropoulos GP, Boehringer A, Celnik P, Edwards MJ, Ferrucci R, et al. Non-invasive cerebellar stimulation—a consensus paper. Cerebellum. 2014;13(1):121–38.
Benussi A, Dell'Era V, Cotelli MS, Turla M, Casali C, Padovani A, et al. Long term clinical and neurophysiological effects of cerebellar transcranial direct current stimulation in patients with neurodegenerative ataxia. Brain Stimul. 2017;10(2):242–50.
Parker CC, Evans OB. Metabolic disorders causing childhood ataxia. Semin Pediatr Neurol. 2003;10(3):193–9.
Vedanarayanan VV. Mitochondrial disorders and ataxia. Semin Pediatr Neurol. 2003;10(3):200–9.
Artuch R, Brea-Calvo G, Briones P, Aracil A, Galván M, Espinós C, et al. Cerebellar ataxia with coenzyme Q10 deficiency: diagnosis and follow-up after coenzyme Q10 supplementation. J Neurol Sci. 2006;246(1–2):153–8.
Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PH, Hadjivassiliou M, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med. 2012;10:13.
Verrotti A, D'Egidio C, Agostinelli S, Gobbi G. Glut1 deficiency: when to suspect and how to diagnose? Eur J Paediatr Neurol. 2012;16(1):3–9.
Feil K, Bremova T, Muth C, Schniepp R, Teufel J, Strupp M. Update on the pharmacotherapy of cerebellar ataxia and nystagmus. Cerebellum. 2016;15(1):38–42.
Acknowledgements
The author thanks the patients and their families, who participated in the Manitoba study, the organizers of the conference, the University of Manitoba, the Health Science Centre Foundation and the Manitoba Medical Service Foundation, the Children’s Hospital Research Institute of Manitoba, and the Children Hospital Foundation. The author also thanks Dr. Fran Booth for her helpful comments on the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
None.
Conflict of Interest
The author declares that he has no conflict of interest.
Rights and permissions
About this article
Cite this article
Salman, M.S. Epidemiology of Cerebellar Diseases and Therapeutic Approaches. Cerebellum 17, 4–11 (2018). https://doi.org/10.1007/s12311-017-0885-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12311-017-0885-2
Keywords
- Cerebellum
- Motor coordination
- Epidemiology
- Management
- Treatment