Presentation
Both the hereditary and sporadic forms usually present in young adulthood, and are characterized by atrophy of cerebellar or brainstem structures. Currently, cerebellar ataxia lack effective disease-modifying therapies. [clinicaltrials.gov]
A 50-year-old man presented with 9-years history of progressive ataxia. His father had undiagnosed ataxia. Examination showed ataxia and pyramidal signs. Brain MRI: olivopontocerebellar atrophy; spine MRI: global spinal cord atrophy ( Figure ). [scielo.br]
The Clinical Presentation of A-T …almost always includes the onset of cerebellar ataxia between the ages of two and five years. [atcp.org]
The age of onset in affected individuals is also variable, with symptoms presenting from birth through late decades of life. [centogene.com]
Manifestations that present in infancy and early childhood include muscle weakness, wasting, hypotonia, poor feeding, failure to thrive and loss of motor milestones. [orpha.net]
Entire Body System
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Pain
What Is Chronic Pain? Pathways Through Pain: Acceptance If you live with chronic pain, you know that chronic pain is different. Ed Covington, MD, director of the Cleveland Clinic Pain Management Program, explains some of the physiology of pain. [theacpa.org]
Management Frontiers in Medicine Zika Virus Ebola Virus Epidemics Climate Crisis and Health E-Cigarettes and Vaping-Related Disease European Society for Medical Oncology (ESMO) View all topics Health Policy Epidemics Pain Management Ebola Virus Multimedia [nejm.org]
His work has ranged from the association of central cardiovascular and pain control to the neurobiological basis of hypertension, and the molecular pathways driving Alzheimer’s disease. [friedreichsataxianews.com]
Other symptoms include chest pain, shortness of breath, and heart palpitations. [secure.ssa.gov]
Friedreich's ataxia may also lead to chest pain, shortness of breath, and heart palpitations. [christopherreeve.org]
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Disability
Neurodegenerative cerebellar ataxias represent a group of disabling disorders for which we currently lack effective therapies. [clinicaltrials.gov]
A more extensive (full) mutation in this gene results in Fragile X syndrome (which causes intellectual disability) in children. [merckmanuals.com]
Spinal cord atrophy in spinocerebellar ataxia type 3 and 6: impact on clinical disability. J Neurol 2008;255:1244-1249. [ Links ]. Gilman S, Sima AA, Junck L, et al. [scielo.br]
Sporadic and hereditary neurodegenerative ataxias are disabling diseases associated with tremors, dysarthria, and cognitive decline, with no effective treatments. [ajmc.com]
Prior research using magnetic resonance imaging (MRI) found that spinal cord atrophy correlates with disability in FA. But these studies of spinal alterations, including reduced area, focused on upper cervical areas and not the full spinal cord. [friedreichsataxianews.com]
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Infertility
Women with the premutation are more likely to have early menopause and infertility problems than women without it. [merckmanuals.com]
Gastrointestinal
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Constipation
Fibromyalgia 101 Fibromyalgia PSA Implantable Medical Devices Living With Fibromyalgia Opioid Induced Constipation Opioid Safety: PSA Preparing for an Opioid Emergency Understanding Migraines Using NSAIDs Safely & Effectively Fibromyalgia 101 A look at [theacpa.org]
Cardiovascular
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Orthostatic Hypotension
Affected people may feel light-headed when they stand because blood pressure does not increase as it normally does (called orthostatic hypotension ). Eventually, they may lose control of the bladder and bowel movements. [merckmanuals.com]
Extracerebellar signs and related diseases: 3,4 Orthostatic hypotension, dysphonia, dystonia, pyramidal signs, and parkinsonism: MSA-C (the most common non-genetic degenerative ataxia). [practicalneurology.com]
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Hypotension
Affected people may feel light-headed when they stand because blood pressure does not increase as it normally does (called orthostatic hypotension ). Eventually, they may lose control of the bladder and bowel movements. [merckmanuals.com]
Extracerebellar signs and related diseases: 3,4 Orthostatic hypotension, dysphonia, dystonia, pyramidal signs, and parkinsonism: MSA-C (the most common non-genetic degenerative ataxia). [practicalneurology.com]
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Hypertension
His work has ranged from the association of central cardiovascular and pain control to the neurobiological basis of hypertension, and the molecular pathways driving Alzheimer’s disease. [friedreichsataxianews.com]
Musculoskeletal
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Fracture
Interactive Medical Cases Image Challenge Images in Clinical Medicine Videos in Clinical Medicine Quick Takes View all multimedia Treating Chronic Spontaneous Urticaria State-Level Action on Drug Prices The Element of Surprise Closed Reduction of a Fractured [nejm.org]
Skin
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Urticaria
Selected Multimedia View all multimedia Audio Clinical Practice Audio Interviews Audio Summaries Interactive Medical Cases Image Challenge Images in Clinical Medicine Videos in Clinical Medicine Quick Takes View all multimedia Treating Chronic Spontaneous Urticaria [nejm.org]
Neurologic
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Cerebellar Ataxia
Currently, cerebellar ataxia lack effective disease-modifying therapies. [clinicaltrials.gov]
The cervical spinal cord was imaged with a 0.5-T MR imaging system in 10 patients with Friedreich's ataxia and in 14 patients with cerebellar ataxias, who served as control subjects. [ajronline.org]
SCA1 is characterized by cerebellar ataxia with variable degrees of ophthalmoplegia, pyramidal signs, and peripheral neuropathy 1. Spinal cord atrophy was described in other SCA subtypes, but not in SCA1 2. [scielo.br]
The following individuals are candidates for cerebellar ataxia panel testing: Individuals with a family history of cerebellar ataxia and presentation of the most common symptoms Individuals without a positive family history of cerebellar ataxia, but with [centogene.com]
Acronym SCA27 Synonyms Cerebellar ataxia autosomal dominant FGF14-related Keywords Any medical or genetic information present in this entry is provided for research, educational and informational purposes only. [uniprot.org]
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Tremor
The tremors may be mistaken for essential tremor (a common tremor disorder that rarely causes any other symptoms). [merckmanuals.com]
Neurodegenerative cerebellar ataxias represent a heterogeneous group of disabling disorders in which progressive ataxia of gait, limb dysmetria, oculomotor deficits, dysarthria and kinetic tremor are the prominent clinical manifestations. [clinicaltrials.gov]
Sporadic and hereditary neurodegenerative ataxias are disabling diseases associated with tremors, dysarthria, and cognitive decline, with no effective treatments. [ajmc.com]
Besides spinal cord and brain MRI scans, appropriate scales were used to assess ataxia — the lack of coordination in voluntary movements – non-ataxia signs, like spasticity and resting tremor, and patients’ ability to conduct activities of daily living [friedreichsataxianews.com]
[…] onset Young adult: SCA 1, 2, 3, 21 Older adult: SCA 6, 35, 36 ; 37 Childhood: SCA 2, 7, 13, 27, DRPLA, 25 Anticipation Some SCA: 1, 2, 3, 6, 7, 8, 10, 12, 17, 22, DRPLA More prominent in SCA 7 & DRPLA Ataxia Truncal: SCA 1 ; 2 ; 6 ; 14 ; 28 ; 31 ; 36 Tremor [neuromuscular.wustl.edu]
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Myelopathy
Pyramidal signs, sensory loss: acquired myelopathies; genetic myelopathies [adrenomyeloneuropathy; hereditary spastic paraparesis (HSP)]; Friedrich’s ataxia (FA); MS; NS. [practicalneurology.com]
It is important to differentiate this sign from thoracic limb spasticity or hypertonicity, which often accompanies proprioceptive ataxia secondary to cervical myelopathies. [vin.com]
MRI of the spinal cord in myelopathy complicating vitamin B12 deficiency: two additional cases and a review of the literature. Neuroradiology 1999 ; 41 : 271 –74 Clinical condition: ataxia Copyright American Society of Neuroradiology [ajnr.org]
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Abnormal Gait
Princeton's WordNet Friedreich's ataxia, herediatry spinal ataxia (noun) sclerosis of the posterior and lateral columns of the spinal cord; characterized by muscular weakness and abnormal gait; occurs in children How to pronounce herediatry spinal ataxia [synonyms.com]
Ataxia is a neurological feature of abnormal gait due to the lack of appropriate muscle coordination and it is a common clinical symptom in hundreds of different diseases. [centogene.com]
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Resting Tremor
Besides spinal cord and brain MRI scans, appropriate scales were used to assess ataxia — the lack of coordination in voluntary movements – non-ataxia signs, like spasticity and resting tremor, and patients’ ability to conduct activities of daily living [friedreichsataxianews.com]
Parkinsonism was present if at least two out of three manifestations were documented - bradykinesia, rigidity, and resting tremor (items 11 and 12 of NESSCA) [ 23, 25 ]. [ojrd.biomedcentral.com]
Workup
Other Pathologies
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Gliosis
July 1994, Volume 163, Number 1 Citation: American Journal of Roentgenology. 1994;163: 187-191. 10.2214/ajr.163.1.8010211 ABSTRACT : Loss of myelinated fibers and gliosis in the posterior and lateral columns of the spinal cord are histopathologic hallmarks [ajronline.org]
Microscopic examination of these structures reveals neuronal loss, axon and myelin degeneration, and gliosis. Similar changes are seen in autonomic nuclei of the hypothalamus, brainstem and spinal cord and in many other nuclei. [neuropathology-web.org]
Pathophysiology The major pathophysiologic finding in Friedreich ataxia is a "dying back phenomena" of axons, beginning in the periphery with ultimate loss of neurons and a secondary gliosis. [emedicine.medscape.com]
In pernicious anemia there may be early localized or relatively diffuse cord swelling with increased T2 SI that is most evident in the posterior columns. 35 Late atrophy and persistent gliosis may develop, or all findings may resolve with treatment. 35 [ajnr.org]
Treatment
Treatment with cerebello-spinal tDCS seems to have a significant effect in helping patients with neurodegenerative ataxia and could be viewed as a potential line of treatment for rehabilitation. Reference Benussi A, Dell’Era V, Cantoni V, et al. [ajmc.com]
After the intervention, patients will be reassessed with a clinical and neurophysiological evaluation at 2 weeks, 1 months and 3 month after treatment. [clinicaltrials.gov]
To identify relevant publications, a PubMed search using the terms “treatments of cerebellar ataxias,” “degenerative cerebellar ataxia treatment,” and “treatment of hereditary cerebellar ataxia” was conducted. [movementdisorders.org]
But some possible breakthrough treatments are being studied. Some medicines with antioxidant properties have shown some promise. Treatment focuses on easing symptoms and maintaining comfort and function for as long as possible. [cedars-sinai.org]
Prognosis
What is the prognosis for ataxia? Ataxia is the sign of an underlying disease or illness and the prognosis depends upon the response to treatment of that underlying cause. [rxlist.com]
Prognosis The prognosis depends on the age of symptom onset. An earlier onset is associated with a more severe and rapidly progressive disease. The documents contained in this web site are presented for information purposes only. [orpha.net]
Prognosis for Friedreich’s Ataxia The symptoms of Friedreich's ataxia can shorten life expectancy, especially when heart disease is a factor. However, some people with less severe cases of Friedreich's ataxia live full lifespans. [quantumrehab.com]
Disease progression and severity often depend on the type of SCA. [1] Most available information on the prognosis of SCA is based on the four most common types: SCA1, SCA2, SCA3 and SCA6. [rarediseases.info.nih.gov]
Etiology
CCA was defined as an SCA of unknown etiology with imaging evidence of isolated cerebellar atrophy. [movementdisorders.org]
Etiology SCA7 is due to a CAG trinucleotide repeat in the ataxin 7 ( ATXN7 ) gene (3p21.1-p12). This mutation leads to degeneration in the cells of the retina, cerebellum and brainstem. [orpha.net]
All possible etiologies should be considered when the clinical course is not firmly established. [practicalneurology.com]
While the etiology of each SCA is unique and some are still unknown, many are caused by an expansion of Cytosine-Adenine-Guanine (CAG) nucleotide repeats. [eyewiki.aao.org]
Brain abscesses: etiologic categorization with in vivo proton MR spectroscopy. Radiology 2004 ; 230 : 519 –27 Kato Z, Kozawa R, Teramoto T, et al. Acute cerebellitis in primary human herpesvirus-6 infection. [ajnr.org]
Epidemiology
This Primer discusses the epidemiology of SCAs, the complex mechanisms underlying them and how they are diagnosed and managed in the clinic. [nature.com]
Summary Epidemiology The estimated worldwide prevalence of SCA7 is less than 1/100,000 and it is thought to account for 2-4% of all forms of SCA (up to 7% in Asian populations). [orpha.net]
The Global Epidemiology of Hereditary Ataxiaand Spastic Paraplegia: A systematic review of prevalence studies. Neuroepidemiology 2014; 24:174-183. Ashizawa T, Figueroa KP, Perlman SL, et al. [rarediseases.org]
The global epidemiology of hereditary ataxia and spastic paraplegia: a systematic review of prevalence studies. Neuroepidemiology. 2014;42(3):174-83. 6.0 6.1 6.2 6 Paulson HL. The spinocerebellar ataxias. [eyewiki.aao.org]
Epidemiology Frequency Friedreich ataxia is a relatively common disorder. It is the most common autosomal recessive ataxia, accounting for approximately 50% of all cases of hereditary ataxia. [emedicine.medscape.com]
Pathophysiology
Clinical, genetic, molecular, and pathophysiological insights into spinocerebellar ataxia type 1. Cerebellum 2008;7:106-114. [ Links ]. Lukas C, Hahn HK, Bellenberg B, et al. [scielo.br]
Clinical, genetic, molecular, and pathophysiological insights into spinocerebellar ataxia type 1. Cerebellum. 2008;7(2):106-14. doi: 10.1007/s12311-008-0009-0. Review. Zoghbi HY, Orr HT. [ghr.nlm.nih.gov]
The pathophysiology of SCA depends on the function of the responsible gene. In some cases, the function of the gene and the pathway whereby cerebellum is damaged has not been discovered. [cancertherapyadvisor.com]
The neuropathology, pathophysiology and genetics of multiple system atrophy. Neuropathol Appl Neurobiol. 2012;38:4-24. PubMed Koeppen AH, Mazurkievicz JE. Friedreich Ataxia: Neuropathology Revised. J Neuropathol Exp Neurol 2013;72(2):78-90. [neuropathology-web.org]
Pathophysiology The major pathophysiologic finding in Friedreich ataxia is a "dying back phenomena" of axons, beginning in the periphery with ultimate loss of neurons and a secondary gliosis. [emedicine.medscape.com]
Prevention
Can ataxia be prevented? Since ataxia is the sign of an underlying disease, it may not necessarily be preventable. However, avoiding external causes of ataxia (environmental chemicals and toxins) may prevent some individuals from developing ataxia. [rxlist.com]
It prevents the proper reading of the gene and stops frataxin from being made and assembled. [chop.edu]
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]
How can spinocerebellar ataxia be prevented? There are no disease-modifying therapies, including none that prevent or postpone symptom onset in individuals carrying the mutated genes. [cancertherapyadvisor.com]