Machado-Joseph disease, also known as spinocerebellar ataxia 3, is a progressive, degenerative nervous system disorder affecting the cerebellum, brain stem, basal ganglia, thalamus and cerebral cortex. It is characterized by varying degrees of motor and non-motor symptoms and is caused by a mutation in the ATXN3 gene located on chromosome 14.
Machado-Joseph disease, also known as spinocerebellar ataxia 3, (MJD/SCA3) is a rare disease characterized by varied phenotypic features and progressive neurodegeneration. It is caused by a trinucleotide repeat expansion (CAG) related to the mutation in the ATXN3 gene located at chromosome 14q32.1 . Clinical presentation consists of motor, as well as, non-motor manifestations. Motor manifestations are noticed initially between the age of 30 and 40 years and they include cerebellar ataxia, gait instability, incoordination of limb movements, and intentional tremor . Spasticity is a common feature with lower limbs being more frequently affected . Later, other motor problems like dysphagia, dysarthria, and truncal ataxia start to develop. Diplopia is a common ocular complaint . Dystonia and parkinsonism are two movement disorders which are frequently noticed in MJD/SCA3 along with peripheral neuropathy, tactile and proprioceptive hypoesthesia   . Non-motor manifestations include chronic pain, cramps, fatigue, sleep disorders, and depression, while autonomic symptoms like nocturia, urinary incontinence, cold intolerance and hypohidrosis may also be present . A majority of MJD/SCA3 patients have excessive daytime sleepiness with impaired nocturnal sleep , insomnia , and restless legs syndrome. Sleep disorders are seen more frequently in older adults with a long-standing disease. About half of the patients complain of chronic pain, especially in the lumbar region . Minor cognitive and behavioral difficulties, but not frank dementia, are noticed in MJD/SCA3 patients .
Three types of MJD/SCA3 have been identified with onset and severity being their differentiating features:
- Type I MJD/SCA3 has an early onset in the 1st to the 3rd decades with a rapid progression. It is characterized by spastic dystonia, ataxia, athetosis, ophthalmoplegia, and exophthalmos. Mental and intellectual abilities are most frequently normal.
- Type II MJD/SCA3 has an onset between the 2nd and 5th decade with a slower progression. Ataxia and limb incoordination are its characteristic features along with spasticity.
Entire Body System
Jaw & Teeth
The diplopia in SCA3/MJD cases is, therefore, attributed, at least in part, to the impairment of the vergence eye movements. [ncbi.nlm.nih.gov]
[…] of age Symptoms slowly worsen over time Muscle twitching Numbness, tingling, cramps, and pain in the hands, feet, arms, and legs (neuropathy) Loss of muscle tissue (atrophy) Many individuals with MJD also have vision problems such as double vision (diplopia [rarediseases.about.com]
Most have double (diplopia) or blurred vision, loss of color vision, and inability to regulate eye movements. Some have Parkinson-like symptoms. There may be sleep disturbance, cramps, and urinary bladder dysfunction. [sci.rutgers.edu]
Symptoms Vision problems: Bulging eyes Double vision (diplopia) Blurred vision Loss of ability to distinguish color and/or contrast Involuntary eye movements Supranuclear opthalmoplegia – the inability to voluntarily move the eyes in all directions 14 [slideshare.net]
The shared features include nystagmus in the horizontal direction, orbicularis oculi contractions, and bilateral esotropia. The findings indicate the importance of the inherent ophthalmological features expressed in MJD. [ncbi.nlm.nih.gov]
- Eye Movements Abnormal
Eye movement abnormalities correlate with genotype in autosomal dominant cerebellar ataxia type I. Ann Neurol 1998 ; 43 : 297 –302. Bürk K, Abele M, Fetter M, et al. Autosomal dominant cerebellar ataxia type I. [jnnp.bmj.com]
- Retinal Pigmentation
Dystrophic changes in the retinal pigment epithelium have rarely been described but may be one of the characteristic complications of Machado--Joseph disease. [ncbi.nlm.nih.gov]
[…] disorder) MJD spinocerebellar ataxia type 3 spinocerebellar ataxia 3 Azorean disease Nigrospinodentatal Degeneration MACHADO-JOSEPH DISEASE; MJD Autosomal dominant striatonigral degeneration Nigro-spino-dentatal degeneration with nuclear ophthalmoplegia [wikidata.org]
OBJECTIVE: To investigate the related factors of international cooperative ataxia rating scale (ICARS) and scale for the assessment and rating of ataxia scores (SARA) in patients with spinocerebellar ataxia type 3/Machado-Joseph disease. [ncbi.nlm.nih.gov]
- Cerebellar Ataxia
From Wikidata Jump to navigation Jump to search autosomal dominant cerebellar ataxia that is characterized by slow degeneration of the hindbrain and has material basis in expansion of CAG triplet repeats (glutamine) in the ATXN3 gene Azorean disease [wikidata.org]
Recently, there have been a few reports of its potential role in the treatment of cerebellar ataxia. We report the first case of a patient with Machado-Joseph disease in which we successfully treated cerebellar ataxia. [ncbi.nlm.nih.gov]
He used a wheelchair since 54 years of age, due to severe cerebellar ataxia. He had a complete limitation of upward movements of his eyes and partial limitation of lateral movements, without lid retraction or nystagmus. [doi.org]
The non-MJD group consisted of three patients with familial episodic ataxia type 2 (EA-2), two with SCA6, two with undiagnosed autosomal dominant cerebellar ataxia, and four with sporadic cerebellar ataxia. [jnnp.bmj.com]
The frequency of nystagmus was calculated for the 3 groups. RESULTS: Nystagmus was present in 88% of the MJD patients. [ncbi.nlm.nih.gov]
In the five non-MJD patients standard caloric testing elicited nystagmus. The presence of caloric induced nystagmus made the irrigation of ice water unnecessary. [jnnp.bmj.com]
- Postural Instability
Postural instability is often an early feature. We discuss the distinction of this entity from the olivopontocerebellar atrophies. [ncbi.nlm.nih.gov]
Clinical features include progressive ataxia, DYSARTHRIA, postural instability, nystagmus, eyelid retraction, and facial FASCICULATIONS. DYSTONIA is prominent in younger patients (referred to as Type I Machado-Joseph Disease). [hon.ch]
- Neurologic Manifestation
Clinical presentation of MJD/SCA3 resembles other neurologic disorders like Parkinson's disease and multiple sclerosis. Therefore diagnosis based on clinical features, family history, and genetic testing, requires an experienced neurologist for interpretation. A family history of neurological disorders should be inquired about during the preliminary interview. Predictive genetic testing in the absence of symptoms can be performed in suspected cases with a positive family history . During the physical examination, gaze-evoked nystagmus, abnormal saccades, decreased smooth pursuit gain, impaired vestibulo-ocular reflex, and supranuclear vertical gaze palsy may be noticed . Lid retraction and decreased blinking may lead to the appearance of “bulging eyes" which is characteristic of MJD/SCA3 . The diagnostic test to detect MJD/SCA3 is the direct determination of the number of abnormal CAG triplets in the DNA of affected patients using genetic testing which is available in specialized laboratories.
Neuroimaging studies like magnetic resonance imaging (MRI) help to demonstrate the extent of neural degeneration. MRI may be normal in the early stages of MJD/SCA3 but typical findings include brainstem and cerebellar atrophy . Single-photon emission computed tomography (SPECT) studies of the brain have shown poor perfusion in the parietal lobes, inferior portion of the frontal lobes, medial and lateral portions of the temporal lobes, basal ganglia, and cerebellar hemispheres and vermis . Magnetic resonance spectroscopy (MRS) of the deep white matter has demonstrated changes indicative of axonal dysfunction, although MRI in the same study did not reveal any abnormalities .
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