What is Dysdiadochokinesia In Multiple Sclerosis?

A Feature of Cerebellar Ataxia in MS

A neurologist examines a brain scan.
A neurologist examines a brain scan. Chris Ryan/Getty Images

Dysdiadochokinesia refers to a person's inability to perform rapid, alternating movements. This is a common sign in multiple sclerosis (MS) caused by one or more lesions in the cerebellum.

How Can My Doctor Detect Dysdiadochokinesia?

During a neurological exam, the presence or degree of dysdiadochokinesia can be evaluated in several ways, including:

  • Having the patient alternately flip back and forth the right hand against a stable surface like a table, the patient's own thigh or left hand) as rapidly as possible; repeat for the left hand.
  • Asking the patient to demonstrate the movement of turning a doorknob or screwing in a lightbulb.

A person with dysdiadochokinesia will be unable to perform the above tests in a correct and coordinated fashion. Their movements may be slowed, unusual, or clumsy.

What Other Neurological Problems May Occur With Dysdiadochokinesia?

Ataxia: The term dysdiadochokinesia fits within a family of neurological problems called ataxia. Ataxia comes from the Greek word "a taxis" which means "without order." So a person with MS-related ataxia has coordination and balance problems, stemming from a lesion within the cerebellum.

Ataxia can affect body movements, like walking, balance, and fine motor movements, like writing or eating. It can also cause slowed eye movements, problems with swallowing, and speaking difficulties, like scanned speech—a form of dysarthria.

Dysmetria: Dysmetria is another neurological sign that may appear when MS lesions occur in the cerebellum, similar to dysdiadochokinesia.

Dysmetria refers to a person's inability to judge distance. The nose-to-finger test where the patient is asked to touch their nose, then the doctor’s finger, in rapid succession, is used to examine this sign.

How are Dysdiadochokinesia and Other Forms of Ataxia Treated?

Treating dysdiadochokinesia and cerebellar ataxia, in general, is challenging, and there are no specific strategies that are scientifically supported at this time.

Sometimes medications used to treat tremor are used to treat ataxia, and at times, surgery may be considered. But, again, the scientific evidence is limited.

That being said, one study in the Journal of Neurology found that physical therapy and occupational therapy may provide some benefit.

For example, specific therapy strategies that target ataxia-related mobility and balance problems may include:

  • learning how to prevent falls
  • modifying a person's home (for example, installing grab rails, removing loose carpets, and placing nonskid mats
  • learning how to maintain an upright, controlled position
  • treadmill walking to improve gait

Occupational therapy may also improve symptoms of depression, which is common in people who suffer from ataxia.

Sources:

Fonteyn EM et al.The effectiveness of allied health care in patients with ataxia: a systematic review.J Neurol. 2014 Feb;261(2):251-8.

Khan F, Amatya B, Turner-Stokes L. Symptomatic therapy and rehabilitation in primary progressive multiple sclerosis. Neurol Res Int. 2011

Mills RJ, Yap L, Young CA. Treatment for ataxia in multiple sclerosis.Cochrane Database Syst Rev. 2007 Jan24;(1):CD005029.

National Ataxia Foundation. Diagnosis of Ataxia.

Shah P. Symptomatic management in multiple sclerosis. Ann Indian Acad Neurol. 2015 Sep;18(Suppl 1):S35-S42.

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