Ataxia management: low-tech approaches

In his 1973 book ‘Small Is Beautiful’, the economist EF Schumacher argued that technological development and economic growth should be centred on the needs of individuals and communities, and that bigger (unregulated expansion) was not necessarily better.1 We can make a similar case regarding highly technical interventions to manage people with chronic and progressive neurological disorders, including degenerative ataxia. Spectacular advances in genomics appear to offer incredible opportunities to influence the natural histories of ‘untreatable’ conditions, using technologies such as gene silencing/editing and the therapeutic use of agents such as antisense oligonucleotides. However, these treatments, even if proven effective, will be affordable for only a small proportion of patients worldwide. By focusing on these potentially dramatic treatments, patients (and their families) might be left feeling that only technically advanced and expensive interventions will be beneficial, with consequent therapeutic nihilism. Can we do more for our patients with what…

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