**6. Management of ataxia in MS**

Management of ataxia and tremor encompasses a variety of available treatments, ranging from pharmacological approaches, surgical strategies to neurorehabilitation [10, 70]. The effectiveness and safety of treatments for ataxia in MS are not well understood; however, neurosurgery and rehabilitation procedures may be at least somewhat helpful [8]. Ataxia and tremor are challenging symptoms for management and treatments are supportive only [10, 11, 71]. Broadly speaking, the management of MS is based either on symptomatic treatments for established symptoms and/ or disease-modifying therapies (DMTs), which aim to alleviate the impact of this condition [13].

Surgical procedures like deep brain stimulation (DBS) may be useful for some patients and prior to invasive procedures, a team examination of each individual is necessary [10]. The most popular non-pharmacological treatment for MS ataxia is physiotherapy, which is used frequently. Exercises designed specifically for balance that facilitate somatosensory and motor strategies are typically used, albeit to various degrees [72]. Task-oriented training also improves ambulation and postural control in MS patients by fostering motor learning [73]. Combinations of these physiotherapy techniques are generally considered to be highly beneficial for MS patients [74].

Finding new treatment approaches will be aided by a better understanding of the pathophysiology of cerebellar disease in MS which will help to treat its related ataxia and tremor. Hence, treating cerebellar disorders and offering neuroprotection inside the cerebellum are urgently needed while newer treatments are being tested, like stem cell therapy. The possibility of stem cell therapies for MS cerebellar pathology is particularly alluring, given the revelation that Purkinje cell fusion is a potential neurorestorative mechanism [13]. A summary of treatment modalities and options for the ataxia of MS patients is provided in **Table 4** [75–77].
