What is Cerebellar Atrophy?
Cerebral atrophy (atrophy of the brain) occurs when brain tissue degenerates and loses neurons and the connections between them. Atrophy can be generalized, which means the entire brain has shrunk; or it can be focal, affecting only a certain area of the brain and decreasing the functions that area of the brain controls. [Source: BrainFacts.org]
Cerebellar atrophy is a focal cerebral atrophy marked by a degeneration of the cerebellum, which is the part of the brain that sits under the cerebrum, behind the brain stem. It is divided into two hemispheres. The cerebellum helps regulate voluntary movements such as posture, balance, coordination and speech. It's what allows for smooth, balanced and precise movement.
Damage to the cerebellum results in a lack of balance, slow movements, tremors, which causes shaking, and unstable eye movements. It can make certain physical tasks difficult and unsteady. The symptoms of cerebellar atrophy are similar to a stroke.
Symptoms of cerebellar degeneration include:
- Unsteady, lurching walk, which often includes a back and forth tremor in the main part of the body
- Slow, unsteady, jerky movements in the arms or legs
- Slow and slurred speech
- Nystagmus: small rapid movements in the eyes.
Cerebellar Atrophy Causes
Conditions that can lead to cerebellar degeneration include seizures, and other cerebellar disorders. Cerebellar degeneration has also been linked to toxins in the brain from ethanol, chemotherapy treatments and phenytoin.
According to research on the link between cerebellar atrophy and Dilantin side effects, cerebellar atrophy tends to show up in patients after long-term use of phenytoin and when drug serum levels are above the therapeutic range. However, cerebellar atrophy has also reportedly occurred when the drug level appeared to be in the normal range.
Several studies have shown that cerebellar toxicity caused by long-term use of phenytoin can cause cerebellar atrophy.
A study published in 2003 found that moderate to severe atrophy was linked to long term use of Dilantin.
Studies have also found that cerebellar atrophy can also affect children who take phenytoin sodium to treat their epilepsy.
Since seizures can also cause cerebral atrophy, a 1994 study took this fact into account because patients taking phenytoin typically suffer from seizures. That study, which was the first to look at the connection, found that patients exposed to phenytoin as a group had significantly smaller cerebelli compared to non-exposed patients.
Cerebellar Atrophy Treatment
Recovery from cerebral atrophy and localized cerebellar atrophy is reportedly possible when patients stop taking Dilantin. Withdrawal from phenytoin is monitored by a doctor.
However, in some cases when there is chronic treatment with phenytoin or acute toxicity caused by Dilantin that led to cerebral atrophy, some of the injuries were permanent, specifically the cerebellar ataxia, which is the lack of muscle coordination.
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- Serum levels of phenytoin sustained above the optimal range may produce confusional states referred to as "delirium," "psychosis," or "encephalopathy," or rarely irreversible cerebellar dysfunction and/or cerebellar atrophy. (addition of cerebellar atrophy).
- Nervous System: Cerebellar atrophy has been reported, and appears more likely in settings of elevated phenytoin levels and/or long-term phenytoin use. (addition to first paragraph)