A number of hereditary ataxias are caused by inborn errors of metabolism (IEM), most of which are highly heterogeneous in their clinical presentation. Prompt diagnosis is important because disease-specific therapies may be available. In this review, we offer a comprehensive overview of metabolic ataxias summarized by disease, highlighting novel clinical trials and emerging therapies with a particular emphasis on first-in-human gene therapies. We present disease-specific treatments if they exist and review the current evidence for symptomatic treatments of these highly heterogeneous diseases (where cerebellar ataxia is part of their phenotype) that aim to improve the disease burden and enhance quality of life. In general, a multimodal and holistic approach to the treatment of cerebellar ataxia, irrespective of etiology, is necessary to offer the best medical care. Physical therapy and speech and occupational therapy are obligatory. Genetic counseling is essential for making informed decisions about family planning.
Keywords: GM2-gangliosidosis; Niemann-Pick type C; abetalipoproteinemia; acetyl-DL-leucine; acetyl-L-leucine; biomarkers; cerebellar ataxia; cerebrotendinous xanthomatosis; disease-modifying treatment; disorders of carbohydrate metabolism; hereditary metabolic ataxia; inborn error of metabolism; lysosomal storage disorders; metabolic diseases; neurodegeneration; neuroprotection; ocular motor; symptomatic treatment.