Exercise offers ‘profound’ benefits for ataxia, research suggests

Zhen Yan, PhD, an exercise researcher at the University of Virginia School of Medicine, is urging clinical trials of exercise in patients with Friedreich’s ataxia after finding that physical activity has a “profound” protective effect in mouse models of the debilitating genetic disease. Dan Addison | UVA Health

A top exercise researcher at the University of Virginia School of Medicine is urging clinical trials of exercise in patients with Friedreich’s ataxia after finding that physical activity has a “profound” protective effect in mouse models of the debilitating genetic disease.

Friedreich’s ataxia typically limits patients’ ability to exercise. But the new findings from UVA’s Zhen Yan, PhD, suggest that well-timed exercise programs early in life may slow the progression of the disease, which robs patients of their ability to walk.

The finding could prove particularly important because genetic testing is currently not mandatory, and there are no effective treatments for the condition.

“When dealing with a genetic disease, we often hope that gene therapy is advanced to a point with great precision and efficiency that we can replace the defect gene in the whole genome and in all the affected cells in the body, but the reality is that we are not there yet,” said Yan, director of the Center for Skeletal Muscle Research at UVA’s Robert M. Berne Cardiovascular Research Center. “This study points to a promising alternative approach of exercise intervention to promote the expression of an iron regulator to bypass the defect gene in maintaining normal mitochondrial function. This could fundamentally change for the good the life of Friedreich’s ataxia patients.”

About Friedreich’s Ataxia

Friedreich’s ataxia affects about 1 in 50,000 people. The disease is caused by a genetic mutation that impairs mitochondria, the powerhouses of cells. Symptoms typically appear between ages 5 and 15, though sometimes later; these symptoms include difficulty moving, poor balance, muscle weakness, type 2 diabetes and heart failure. Patients are often confined to a wheelchair within 10 to 20 years of symptom onset. Some patients with advanced disease become completely incapacitated, and the disease can lead to early death.

In a lab model of the disease, mice lose ability to run, develop blood sugar problems and show signs of moderate heart problems at 6 months of age, But Yan found that mice that started voluntary long-distance running at 2 months completely avoided those problems.

“We conclude that endurance exercise training prevents symptomatic onset of FRDA [Friedreich’s ataxia] in mice associated with improved mitochondrial function and reduced oxidative stress,” the researchers report in a scientific paper on the findings. “These preclinical findings may pave the way for clinical studies of the impact of endurance exercise in FRDA patients.”

The Many Benefits of Exercise

The discovery is the latest in a series from Yan that speaks to the benefits of exercise. He recently made headlines around the world when he determined that exercise may help prevent a potentially deadly complication of COVID-19 known as acute respiratory distress syndrome.

“Unlike drug therapy, increased physical activity has very few side effects. In fact, regular exercise has positive effects to literally all vital organ systems in our body,” he said. “You will benefit from just about any type of exercise as you age, as long as you’re not at risk of injury.”

Ataxia – what are the different types of Ataxia




Types of Ataxia

Types of Ataxia




Some types of ataxia affect children from an early age, while other types may not develop until much later in adulthood.

Depending on the type of ataxia, the symptoms may stay the same, get progressively worse, or slowly improve.

Some of the main types of ataxia are described below. Read about the causes of ataxia for information about why these different types of ataxia develop.

Friedreich’s ataxia

Friedreich’s ataxia is the most common type of hereditary ataxia (caused by genes you’ve inherited). It’s thought to affect at least 1 in every 50,000 people.

Symptoms usually first develop before the age of 25, although it can develop in people much older than this.

Signs and symptoms of Friedreich’s ataxia can include:

problems with balance and co-ordination, often causing wobbliness, clumsiness and frequent falls

increasingly slurred, slow and unclear speech (dysarthria)

increasing weakness in the legs – many people find walking difficult and need to use a wheelchair after around 10 to 20 years

difficulty swallowing (dysphagia)

abnormal curvature of the spine (scoliosis)

total or partial vision loss and hearing loss

diabetes

thickening of the heart muscles (hypertrophic cardiomyopathy), which can cause chest painbreathlessness and an irregular heartbeat

loss of sensation in the hands and feet (peripheral neuropathy)

The symptoms of Friedreich’s ataxia usually get gradually worse over many years. People with the condition tend to have a shorter life expectancy than normal. Many people live until at least their 30s, and some can live into their 60s or beyond.

Ataxia-telangiectasia

Ataxia-telangiectasia (AT) is a rarer type of hereditary ataxia, affecting around 1 in every 100,000 children. Symptoms usually begin in early childhood, although they can sometimes develop later.




Signs and symptoms of AT can include:

difficulty walking – most children need to use a wheelchair by 10 years of age

increasingly slurred, slow and unclear speech (dysarthria)

difficulty swallowing (dysphagia)

small spider-like clusters of red blood vessels in the corner of their eyes and on their cheeks (telangiectasias)

very slow eye movements, which may mean the person has to move their head a lot to compensate for this

a weakened immune system – children with AT are more vulnerable to infections, particularly infections of the sinuses, lungs and airways, such as pneumonia

an increased risk of cancer, particularly acute lymphoblastic leukaemia or lymphoma – up to 40% of people with AT will develop cancer

The symptoms of AT tend to get worse quite quickly. People with the condition usually live until the age of 19 to 25, although some may live into their 50s.

Spinocerebellar ataxias

Spinocerebellar ataxias (SCAs) are a group of hereditary ataxias that often don’t begin until adulthood, affecting people from the age of 25 up to 80, depending on the type of SCA. Occasionally, some types of SCA begin in childhood.

The symptoms vary depending on the type of SCA. They can include:

problems with balance and co-ordination – many people find walking difficult and need to use a wheelchair after a few years

increasingly slurred, slow and unclear speech (dysarthria)

difficulty swallowing (dysphagia)

muscle stiffness and cramps

loss of sensation in the hands and feet (peripheral neuropathy)

memory loss and difficulties with spoken language

slow eye movement, which means people have to move their head to compensate

reduced bladder control (urinary urgency or incontinence)

Ataxia UK has more detailed information about common subtypes of SCA.

Episodic ataxia

Episodic ataxia is a rare and unusual type of hereditary ataxia where someone experiences episodes of ataxia, but the rest of the time they have no or only mild symptoms.

During an episode, someone with episodic ataxia may experience:

problems with balance and co-ordination

slurred, slow and unclear speech (dysarthria)

muscle spasms

involuntary eye movements (nystagmus)

vertigomigraines and tinnitus

Episodic ataxia usually first develops during the teenage years. The episodes can last from several minutes to hours and are usually the result of certain triggers, such as sudden movement, stress, exercise, caffeine or alcohol.

The symptoms of episodic ataxia may disappear as a person gets older, although sometimes the condition gets gradually worse over time. Medication can often help control attacks, and life expectancy is usually normal.

Other types of ataxia

There are also a number of other types of ataxia that tend to have similar symptoms to those mentioned above. These include:

acquired ataxia – this can affect people of any age and usually develops very quickly over the course of a few days, or sometimes hours; it may improve over time, stay the same or get slowly worse

idiopathic late-onset cerebellar ataxia (ILOCA) – this usually begins at around 50 years of age and gets slowly worse over time

ataxia with vitamin E deficiency – a similar condition to Friedreich’s ataxia caused by problems with the body’s ability to use vitamin E in the diet; it’s often possible to control the symptoms with vitamin E supplements

Helping people with multiple sclerosis cope with ataxia




Helping people with multiple sclerosis cope with ataxia

Helping people with multiple sclerosis cope with ataxia

Wendy Hendrie, Specialist Physiotherapist in Multiple Sclerosis at Norwich MS Centre, introduces ‘Helping people with multiple sclerosis cope with ataxia’, a seminar delivered at the MS Trust conference, 5 November 2013.




What is ataxia? 0:05
How does ataxia affect people with MS? 01:00
Can ataxia be treated? If so, how? 02:25
A restorative/rehabilitation approach 03:00
Compensatory strategies 04:14
Mobility problems 04:42
(walking sticks/crutches 05:25, trekking poles 05:50, weighting mobility aids 06:13, axial weighting 06:48, core stability aids 07:40, temperature control solutions 08:00)
Upper limb problems 08:54:
(weighting 09:28, lycra 10:16, cooling 11:10, peripheral vision 11:50, overshooting 12:55, sensory attraction 13:38)
Postural problems 14:30




Ataxia – find out more about this symptom of multiple sclerosis




Multiple sclerosis awareness

Multiple sclerosis awareness

[Original article on NHS Choices website]




Ataxia is a term for a group of disorders that affect co-ordination, balance and speech.

Any part of the body can be affected, but people with ataxia often have difficulties with:

balance and walking

speaking

swallowing

tasks that require a high degree of control, such as writing and eating

vision

The exact symptoms and their severity vary depending on the type of ataxia a person has.

Types of ataxia

There are many different types of ataxia, which can be divided into three broad categories:

acquired ataxia – where symptoms develop as the result of trauma, a stroke, multiple sclerosis (MS), a brain tumour, nutritional deficiencies, or other problems that damage the brain or nervous system

hereditary ataxia – where symptoms develop slowly over many years and are caused by faulty genes that a person inherits from their parents; the most common type is Friedreich’s ataxia

idiopathic late-onset cerebellar ataxia (ILOCA) – where the brain is progressively damaged over time for reasons that are unclear

Read more about the main types of ataxia.

What causes ataxia?

Ataxia usually results from damage to a part of the brain called the cerebellum, but it can also be caused by damage to other parts of the nervous system.

This damage can be part of an underlying condition such as MS, or can be caused by a head injury, lack of oxygen to the brain, or long-term, excessive alcohol consumption.

Hereditary ataxia is caused by a faulty gene passed on by family members, who may or may not be affected.




Read more about the causes of ataxia.

How ataxia is treated

In most cases, there’s no cure for ataxia and supportive treatment to control the symptoms is necessary.

This may include:

speech and language therapy to help with speech and swallowing problems

physiotherapy to help with movement problems

occupational therapy to help you cope with the day-to-day problems

medication to control muscle, bladder, heart and eye problems

In a few cases, it’s possible to improve ataxia or stop it getting worse by treating the underlying cause.

Read more about treating ataxia.

Outlook

The outlook for ataxia can vary considerably and largely depends on the type of ataxia you have. Some types may remain relatively stable or even improve with time, but most will get progressively worse over many years.

Life expectancy is generally shorter than normal for people with hereditary ataxia, although some people can live well into their 50s, 60s or beyond. In more severe cases, the condition can be fatal in childhood or early adulthood.

For acquired ataxia, the outlook depends on the underlying cause. Some cases may improve or stay the same, while other cases may get gradually worse over time and reduce life expectancy.

What is Ataxia and why does it affect people with multiple sclerosis? Watch this brilliant video from Dulci Hill!




Spasticity in MS

Spasticity in MS

What is Ataxia and why does it affect people with multiple sclerosis?




Check out another brilliant video from Dulci Hill on multiple sclerosis. Please check out her video below!

We have covered the area of ataxia before. Please do have a look at it here.