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Early-Onset Cerebellar Ataxia


Presentation

  • We present a diagnostic algorithm for the adult patient presenting with subacute cerebellar ataxia, based on family history and straightforward clinical characteristics of the patient.[ncbi.nlm.nih.gov]
  • He also present delayed speech and language development.[neurology.org]
Foot Deformity
  • The patient's father did not have any ataxia, but had the same foot deformities as his daughter and a slight peripheral neuropathy. The possible relationship between these clinical features is discussed.[ncbi.nlm.nih.gov]
  • Associated symptoms, such as muscle wasting, sensory disturbances, foot deformity, scoliosis and electrocardiographic abnormalities were encountered less frequently in EOCA than in FA patients.[doi.org]
  • Additional features are progressive external ophthalmoplegia, progressive sensorineural hearing loss , peripheral neuropathy, foot deformity, basal ganglia calcification, short stature, deafness, OA and cervical lipomas.[neuroweb.us]
Hyperlaxity
  • The patient displayed a severe phenotype with early onset cerebellar ataxia complicated by intellectual disability, epilepsy, attention deficit hyperactivity disorder, strabismus, oral apraxia and joint hyperlaxity.[ncbi.nlm.nih.gov]
  • Other unique phenotypic features in our case were strabismus, severe oral apraxia, and joint hyperlaxity, which are all supposedly part of the phenotype of this de novo KCND3 mutation.[bmcmedgenet.biomedcentral.com]
Delayed Speech and Language Development

Workup

  • Comprehensive workup with extended autoimmune laboratory examinations revealed remarkably high serum and CSF GAD-ab levels in both siblings (fig. 1 e, f).[karger.com]
Abnormal ECG
  • Abnormal ECG and echocardiography are seen in approximately 60% of cases. CSF is normal. The condition most frequently confused with FA is HSMN I.[neuroweb.us]

Treatment

  • In some cases, there is no cure but treatment may help with symptoms.[icdlist.com]
  • Management and treatment Treatment is symptomatic, aimed towards the control of spasticity, and should include physiotherapy and pharmacotherapy (that may include spasmolytic drugs such as baclofen).[orpha.net]
  • Tracy M Jones, Jessica D Shaw, Kelly Sullivan and Theresa A Zesiewicz, Treatment of cerebellar ataxia, Neurodegenerative Disease Management, 4, 5, (379), (2014). N. Tirada and L. M.[doi.org]
  • A diagnosis of generalized epilepsy was made and treatment with valproate was initiated alleviating the seizures. Treatment was stopped successfully at 9 years of age.[bmcmedgenet.biomedcentral.com]

Prognosis

  • It is distinguished from Friedreich's ataxia (FA) mainly by the preservation of tendon reflexes, a better prognosis, and the absence of GAA expansion in the frataxin gene.[ncbi.nlm.nih.gov]
  • The prognosis was better in the present series than in cases of Friedreich's ataxia; patients remained ambulant, on average, for more than 10 years longer.[doi.org]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Etiology The exact etiology of EOCARR is still unknown. However, molecular genetic analysis in a Tunisian family confirmed the genetic heterogeneity of this syndrome and mapped the gene locus to chromosome 13q11-12.[orpha.net]
  • She divided those with a known etiology (eg, abetalipoproteinemia, ataxia telangiectasia) from those whose etiology was unknown (eg, Friedreich ataxia, Ramsay Hunt syndrome, cerebellar ataxia with retinal degeneration).[medlink.com]
  • Recent studies have linked GAD-ab cerebellar ataxia with type 1 diabetes mellitus (T1DM), other autoimmune endocrine disorders and, occasionally, even with paraneoplastic etiologies [ 4 ].[karger.com]

Epidemiology

  • Abstract A genetic epidemiologic analysis of early onset cerebellar ataxias (EOCA) with retained tendon reflexes was performed in a defined area of Northwestern Italy. Forty cases diagnosed from 1940 to 1990 were ascertained.[ncbi.nlm.nih.gov]
  • Hall and Marsha Mailick, The Epidemiology of FXTAS, FXTAS, FXPOI, and Other Premutation Disorders, 10.1007/978-3-319-33898-9_2, (25-38), (2016).[doi.org]
  • Summary Epidemiology The prevalence of EOCARR ataxia has been estimated to be around 1/100,000, and the birth prevalence at 1/48,000 births in North-western Italy.[orpha.net]
  • Epidemiology The prevalence of EOCARR ataxia has been estimated to be around 1/100,000, and the birth prevalence at 1/48,000 births in North-western Italy.[rarediseases.info.nih.gov]
  • Epidemiology Prevalence of ADCAs has been estimated as between 0.3 to 2 per 100,000 [ 7 ].[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • VZV infection or reactivation involving the geniculate ganglion of CN VII within the temporal bone is the main pathophysiological mechanism of Ramsay Hunt syndrome.[emedicine.medscape.com]
  • . • Researchers are rapidly learning about the underlying pathophysiology behind the inherited ataxia syndromes.[medlink.com]
  • Physicians are equally disheartened to see exponential progress being made in the understanding of the pathophysiology of a complex disorder but few direct benefits resulting for their patients.[alzheimer-europe.org]
  • Central ataxia, Lower limb tremor, Psychosis, Dementia Damage to GABA-A receptor, Impaired Glucose metabolism,VitB1 deficiency MRI-Superior cerebellar and cerebral atrophy Alcohol abstinence,VitB1 replacement Pathophysiology MRI Treatment Toxins- Alcoholic[slideshare.net]

Prevention

  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.com]
  • Fortunately, there is another vaccine, Zostavax , which is helpful in preventing viral reactivation. Consequently, shingles and Ramsay Hunt syndrome can be either prevented or their symptoms reduced if the vaccine is administered.[medicinenet.com]
  • Pooyafar and Vahid Mansouri, Dental pulp stem cell transplantation ameliorates motor function and prevents cerebellar atrophy in rat model of cerebellar ataxia, Cell and Tissue Research, 10.1007/s00441-018-02980-x, 376, 2, (179-187), (2019).[doi.org]
  • Reducing your risk of stroke by exercising, maintaining a healthy weight, and keeping blood pressure and cholesterol in check can also be helpful in preventing ACA.[healthline.com]
  • Walking becomes difficult as the sufferers may have to keep their feet apart to prevent falling over. A wheelchair may be required for transportation in most patients with ataxia sooner or later.[news-medical.net]

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