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]
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]
Due to the fact that MJD presents its inheritance in a dominant pattern, there cannot be any recessive carriers of the disease. [physio-pedia.com]
Central/cecocentral scotoma and dyschromatopsia may be present. [12] SCA2 : Prominent slow saccades are found early in the disease, while other types of SCA may present with slow saccades late in disease progression. [eyewiki.aao.org]
Neurologic
- Gait Ataxia
People with Friedreich's ataxia develop clumsy, shaky movements of the legs (called gait ataxia) during childhood or early adolescence. In rare cases, symptoms appear in infants and in middle-aged adults. [health.harvard.edu]
Gait ataxia presents itself as a highly variable type of movement pattern in which the individual has difficulties in maintaining postural balance while walking. Individuals with gait ataxia appear to walk in a “drunk-like” state. [physio-pedia.com]
Evidence of positive gene testing and gait ataxia is necessary to determine the underlying gene abnormality that results in this disease to confirm the diagnosis of FRDA. TREATMENT There is currently no effective cure or treatment for FRDA. [secure.ssa.gov]
Even though truncal and gait ataxia, almost always the presenting symptom in A-T, is slowly and steadily progressive, it may be compensated for by the normal development of motor skills between the age s of 2 and 5 years, which may mask the progression [atcp.org]
The term ataxia refers to a group of progressive neurological diseases that affect coordination and balance. Ataxias are often characterized by poor coordination of hands and eye movements, speech problems and a wide-based and unsteady gait. [uofmhealth.org]
- Apraxia
[…] caused by mutations in ATM Ataxia with vitamin E deficiency (AVED), caused by mutations in TTPA Ataxia with oculomotor apraxia type 1 (AOA1) caused by mutations in APTX Ataxia with oculomotor apraxia type 2 (AOA2) caused by mutations in SETX POLG (polymerase [centogene.com]
Other, less consistent features may include : dysarthria and drooling, oculocutaneous telangiectasia, progressive apraxia of eye movements, characteristic hypotonic facies, absence or dysplasia of the thymus gland, recurrent pulmonary infections, susceptibility [atcp.org]
Very rarely: SCA 6 Nystagmus Downbeat: SCA 6 ; EA 2 Head-shaking: SCA 6 Gaze evoked: SCA 1, 3, 6 ; Not 2 Vertical eye movements abnormal: SCA 6 ; 26 ; 30 ; 37 Maculopathy (Visual loss): SCA 7 Pseudoexophthalmos: SCA 1, 2, 3 Ptosis: SCA 7, 28 Oculomotor apraxia [neuromuscular.wustl.edu]
Some of the specific types of genetic ataxia include: Ataxia telangiectasia Ataxia with oculomotor apraxia Dominant spastic ataxias Dominant spinocerebellar ataxias ( SCA ) Episodic ataxia Friedreich's ataxia Recessive spastic ataxias Wilson’s disease [webmd.com]
Autosomal recessive types of hereditary ataxia account for approximately 3:100,000 with Friedreich ataxia, ataxia-telangiectasia, and ataxia oculomotor apraxia being most common. Most of the spastic ataxias are recessively inherited. [blueprintgenetics.com]
- Polyneuropathy
[…] encephalopathy); gluten ataxia in Celiac disease (GA); vitamin deficiency states [e.g. ataxia with vitamin E deficiency or AVED, B1 (thiamine) deficiency]; general medical conditions such as hepatic encephalopathy; infections (HIV, CJD); MS; or sensory polyneuropathy [practicalneurology.com]
[…] 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 In the presence of hypertrophic, inflammatory, or postinfectious polyneuropathies [ajnr.org]
Genes in the Ataxia Panel and their clinical significance Gene Associated phenotypes Inheritance ClinVar HGMD ABCB7 Anemia, sideroblastic, and spinocerebellar ataxia XL 8 9 ABHD12 Polyneuropathy, hearing loss, ataxia, retinitis pigmentosa, and cataract [blueprintgenetics.com]
- 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]
Clinical features of hereditary cerebellar ataxia are poor coordination of movement and abnormal, dysfunctional, wide-based uncoordinated and unsteady gait. [centogene.com]
- Cerebellar Sign
Diffusion-weighted abnormalities (“cortical ribboning”) and symmetric thalamic changes (“pulvinar” sign): CJD Spinal cord MRI is suggested for myelopathic signs. [practicalneurology.com]
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]
Depending upon the severity of symptoms, your child’s doctor will recommend the appropriate treatment. Some of the treatments offered include: Physical therapy Mobility aids such as canes or wheelchairs [shrinershospitalsforchildren.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. [medicinenet.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 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]
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]
[…] repeated CAG code only partially explains the effects of MJD. [4] MJD is the most common form of spinocerebellar ataxia (SCA). [4] On a global scale, spinocerebellar ataxia disorders are considered rare with a prevalence of 0.2-0.3 per 100,000. [5] The epidemiology [physio-pedia.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. [medicinenet.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]