We propose a serotonergic hypothesis for cerebellar ataxia. The levorotatory form of 5 hydroxytryptophan has been shown to be partially active in subtypes of cerebellar ataxia, including cerebellar cortical atrophy (CCA). Buspirone, a 5-HT1A agonist usable in human medicine, has been studied in a group of 14 patients with cerebellar cortical atrophy. Patients were given Buspirone for 2 months. The evaluation of cerebellar ataxia was made by a semi-quantitative scale, 10 fully quantitative measures and measurements of the sway path and sway area of the center of gravity at posturography. The primary endpoints were the modifications of the ataxia scores. At 2 months, the decrease of the ataxia scores was significant, both in the intention-to-treat (14 cases) and target (11 cases) populations. In the target population, secondary endpoints like the time measurements for pronouncing a standard sentence, the time for drawing a ladder and posturographic parameters were significantly improved; the mean global ataxia score was improved by 37.4%. These preliminary data might confirm a link between cerebellar ataxia and the metabolism of serotonin.