Finally, autoimmunity is probably an under-recognised cause of progressive ataxia: as well as patients with antigliadin antibodies there are smaller numbers with various antibodies, including some associated with cancer. Advances in molecular genetics, including the wider and cheaper availability of ‘next-generation sequencing’, have enabled clinicians to identify many more cases with a genetic cause. MR brain scanning can provide diagnostic clues, as well as identify ‘structural’ causes such as tumours and multiple sclerosis. This paper provides suggested diagnostic pathways for the general neurologist, based on Ataxia UK’s guidelines for professionals. Many patients remain undiagnosed (‘idiopathic’ ataxia). Progressive ataxia in adults can be difficult to diagnose, owing to its heterogeneity and the rarity of individual causes.
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