Management of spinocerebellar ataxia

Spinocerebellar ataxias (SCAs) are a group of neurodegenerative diseases characterized by progressive cerebellar dysfunction, which leads to impaired coordination, dysarthria, oculomotor disorders, and subsequently to a marked reduction in quality of life and high disability. In addition to the main motor symptoms, patients often suffer from cerebellar cognitive-affective syndrome, depression, and sleep disturbances. Despite advances in understanding the molecular and genetic underpinnings of SCAs, there are currently no disease-modifying therapies approved by the FDA (U.S. Food and Drug Administration) or EMA (European Medicines Agency), and management remains largely symptomatic, focusing on improving quality of life and functional independence. Recent systematic reviews and clinical guidelines emphasize a combination of pharmacological, non-pharmacological, and novel gene and cell therapies that are currently under investigation, with varying levels of evidence for their efficacy. The transition to precision medicine and early intervention at the pre-ataxic stage are essential for effectively combating neurodegeneration. This review summarizes the latest data on the treatment of SCA, including existing and new treatments, their effectiveness, limitations, and future prospects.