1
|
Jaques CS, Escorcio-Bezerra ML, Pedroso JL, Barsottini OGP. The Intersection Between Cerebellar Ataxia and Neuropathy: a Proposed Classification and a Diagnostic Approach. THE CEREBELLUM 2021; 21:497-513. [PMID: 34368935 DOI: 10.1007/s12311-021-01275-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2021] [Indexed: 12/15/2022]
Abstract
Neuropathy is a common associated feature of different types of genetic or sporadic cerebellar ataxias. The pattern of peripheral nerve involvement and its associated clinical features can be an invaluable aspect for narrowing the etiologic diagnosis in the investigation of cerebellar ataxias. In this review, we discuss the differential diagnosis of the intersection between peripheral nerve and cerebellar involvement, and classify them in accordance with the predominant features. Genetics, clinical features, neuroimaging, and neurophysiologic characteristics are discussed. Furthermore, a diagnostic approach for cerebellar ataxia with neuropathy is proposed according to the different clinical characteristics. This is an Educational and Descriptive review with the aim of medical education for the approach to the patients with cerebellar ataxia and neuropathy. The diagnostic approach to the patient with cerebellar ataxia with neuropathy requires a detailed medical history, phenotyping, characterization of disease progression and family history. Neuroimaging features and the neurophysiological findings play pivotal roles in defining the diagnosis. Establishing an organized classification method for the disorders based on the clinical features may be very helpful, and could be divided as those with predominant cerebellar features, predominant neuropathic feature, or conditions with both cerebellar ataxia and neuropathy. Second, determining the mode of inheritance is critical on cerebellar ataxias: autosomal dominant and recessive cerebellar ataxias, mitochondrial or sporadic types. Third, one must carefully assess neurophysiologic findings in order to better characterize the predominant pattern of involvement: damage location, mechanism of lesion (axonal or demyelinating), motor, sensory or sensory motor compromise, large or small fibers, and autonomic system abnormalities.
Collapse
Affiliation(s)
- Cristina Saade Jaques
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Pedro de Toledo Street, São Paulo, SP, 650, 04023-900, Brazil
| | - Marcio Luiz Escorcio-Bezerra
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Pedro de Toledo Street, São Paulo, SP, 650, 04023-900, Brazil
| | - José Luiz Pedroso
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Pedro de Toledo Street, São Paulo, SP, 650, 04023-900, Brazil.
| | - Orlando Graziani Povoas Barsottini
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Pedro de Toledo Street, São Paulo, SP, 650, 04023-900, Brazil
| |
Collapse
|
2
|
Jaques CS, Pedroso JL, Rocha AJD, Pinto WBVDR, Oliveira ASB, Barsottini OGP. Spinocerebellar ataxia type 3 presenting simultaneously with motor neuron disease and cerebellar ataxia. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:851-852. [PMID: 34133492 DOI: 10.1590/0004-282x-anp-2020-0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 12/08/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Cristina Saade Jaques
- Universidade Federal de São Paulo, Departamento de Neurologia, Unidade de Ataxia, São Paulo, SP, Brazil
| | - José Luiz Pedroso
- Universidade Federal de São Paulo, Departamento de Neurologia, Unidade de Ataxia, São Paulo, SP, Brazil
| | - Antônio José da Rocha
- Santa Casa de São Paulo, Faculdade de Ciências Médicas, Divisão de Neurorradiologia, São Paulo, SP, Brazil
| | | | - Acary Souza Bulle Oliveira
- Universidade Federal de São Paulo, Departamento de Neurologia, Unidade Neuromuscular, São Paulo, SP, Brazil
| | - Orlando G P Barsottini
- Universidade Federal de São Paulo, Departamento de Neurologia, Unidade de Ataxia, São Paulo, SP, Brazil
| |
Collapse
|
3
|
Fardghassemi Y, Tauffenberger A, Gosselin S, Parker JA. Rescue of ATXN3 neuronal toxicity in Caenorhabditiselegans by chemical modification of endoplasmic reticulum stress. Dis Model Mech 2017; 10:1465-1480. [PMID: 29061563 PMCID: PMC5769603 DOI: 10.1242/dmm.029736] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 10/08/2017] [Indexed: 12/13/2022] Open
Abstract
Polyglutamine expansion diseases are a group of hereditary neurodegenerative disorders that develop when a CAG repeat in the causative genes is unstably expanded above a certain threshold. The expansion of trinucleotide CAG repeats causes hereditary adult-onset neurodegenerative disorders, such as Huntington's disease, dentatorubral–pallidoluysian atrophy, spinobulbar muscular atrophy and multiple forms of spinocerebellar ataxia (SCA). The most common dominantly inherited SCA is the type 3 (SCA3), also known as Machado–Joseph disease (MJD), which is an autosomal dominant, progressive neurological disorder. The gene causatively associated with MJD is ATXN3. Recent studies have shown that this gene modulates endoplasmic reticulum (ER) stress. We generated transgenic Caenorhabditiselegans strains expressing human ATXN3 genes in motoneurons, and animals expressing mutant ATXN3-CAG89 alleles showed decreased lifespan, impaired movement, and rates of neurodegeneration greater than wild-type ATXN3-CAG10 controls. We tested three neuroprotective compounds (Methylene Blue, guanabenz and salubrinal) believed to modulate ER stress and observed that these molecules rescued ATXN3-CAG89 phenotypes. Furthermore, these compounds required specific branches of the ER unfolded protein response (UPRER), reduced global ER and oxidative stress, and polyglutamine aggregation. We introduce new C. elegans models for MJD based on the expression of full-length ATXN3 in a limited number of neurons. Using these models, we discovered that chemical modulation of the UPRER reduced neurodegeneration and warrants investigation in mammalian models of MJD. Summary: We introduce a novel C. elegans model for Machado–Joseph disease for use in preclinical drug discovery and identified guanabenz as a potent neuroprotective molecule.
Collapse
Affiliation(s)
- Yasmin Fardghassemi
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM) Montréal, Québec H2X 0A9, Canada.,Département de biochimie et médecine moléculaire, Université de Montréal, Montréal, Québec H3T 1J4, Canada
| | - Arnaud Tauffenberger
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM) Montréal, Québec H2X 0A9, Canada.,Département de pathologie et biologie cellulaire, Université de Montréal, Montréal, Québec H3T 1J4, Canada
| | - Sarah Gosselin
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM) Montréal, Québec H2X 0A9, Canada.,Département de neurosciences, Université de Montréal, Montréal, Québec H3T 1J4, Canada
| | - J Alex Parker
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM) Montréal, Québec H2X 0A9, Canada .,Département de biochimie et médecine moléculaire, Université de Montréal, Montréal, Québec H3T 1J4, Canada.,Département de pathologie et biologie cellulaire, Université de Montréal, Montréal, Québec H3T 1J4, Canada.,Département de neurosciences, Université de Montréal, Montréal, Québec H3T 1J4, Canada
| |
Collapse
|
4
|
Bezerra MLE, Pedroso JL, Braga-Neto P, Abrahao A, de Albuquerque MVC, Borges FRP, Saraiva-Pereira ML, Jardim LB, de Oliveira Braga NI, Manzano GM, Barsottini OGP. Pattern of Peripheral Nerve Involvement in Spinocerebellar Ataxia Type 2: a Neurophysiological Assessment. THE CEREBELLUM 2017; 15:767-773. [PMID: 26708559 DOI: 10.1007/s12311-015-0753-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Peripheral neuropathy is frequent in spinocerebellar ataxia type 2 (SCA2), but the pattern and characteristics of nerve involvement are still an unsettled issue. This study aimed to evaluate the prevalence, extent, and distribution of nerve involvement in SCA2 patients through neurophysiological studies. Thirty-one SCA2 patients and 20 control subjects were enrolled in this study. All subjects were prospectively evaluated through electromyography, including nerve conduction, needle electromyography in proximal and distal muscles of the upper and lower limbs, and sural radial amplitude ratio (SRAR). We aimed to differentiate distal axonopathy from diffuse nerve commitment, characterizing neuronopathy. Nerve involvement was observed in 83.6 % (26 individuals) of SCA2 patients. Among these, 19 had diffuse sensory abnormalities on nerve conduction predominantly on the upper limbs, with diffuse chronic denervation on needle electromyography and elevated SRAR values. Four individuals had only diffuse sensory involvement, and 2 had only motor involvement on needle evaluation and normal nerve conduction. These were interpreted as neuronopathy due to the diffuse distribution of the involvement. One individual had distal sensory axonopathy, with lower limb predominance. In this study, we found neuronopathy as the main pattern of nerve involvement in SCA2 patients and that motor involvement is a frequent feature. This information brings new insights into the understanding of the pathophysiology of nerve involvement in SCA2 and sets some key points about the phenotype, which is relevant to guide the genetic/molecular diagnosis.
Collapse
Affiliation(s)
| | - José Luiz Pedroso
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Pedro Braga-Neto
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil
| | - Agessandro Abrahao
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Franklin Roberto Pereira Borges
- Department of Neurophysiology, Fundação Beneficente, Hospital de Cirurgia, Aracaju, SE, Brazil
- Department of Neurosurgery, Fundação Beneficente, Hospital de Cirurgia, Aracaju, SE, Brazil
| | - Maria Luiza Saraiva-Pereira
- Department of Biochemistry and Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Laura Bannach Jardim
- Department of Internal Medicine and Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | |
Collapse
|
5
|
Farrar MA, Vucic S, Nicholson G, Kiernan MC. Motor cortical dysfunction develops in spinocerebellar ataxia type 3. Clin Neurophysiol 2016; 127:3418-3424. [PMID: 27689815 DOI: 10.1016/j.clinph.2016.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/25/2016] [Accepted: 09/07/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Spinocerebellar ataxia type 3 (SCA3) is an inherited neurodegenerative disorder characterized by cerebellar ataxia and variable expression of clinical features beyond the cerebellum. To gain further insights into disease pathophysiology, the present study explored motor cortex function in SCA3 to determine whether cortical dysfunction was present and if this contributed to the development of clinical manifestations. METHODS Clinical phenotyping and longitudinal assessments were combined with central (threshold-tracking transcranial magnetic stimulation) and peripheral (nerve excitability) techniques in 11 genetically characterized SCA3 patients. RESULTS Short-interval intracortical inhibition was significantly reduced in presymptomatic and symptomatic SCA3 patients (-1.3±1.4%) compared to healthy controls (10.3±0.7%, P<0.0005), with changes evident prior to clinical onset of ataxia and related to worsening severity (R=-0.78, P<0.005). Central motor conduction time was also significantly prolonged in presymptomatic and symptomatic SCA3 patients (7.5±0.4ms) compared to healthy controls (5.3±0.2ms, P<0.0005) and related to clinical severity (R=0.81, P<0.005). Markers of peripheral motor neurodegeneration and excitability did not correlate with cortical hyperexcitability or ataxia. CONCLUSIONS Simultaneous investigation of clinical status, and central and peripheral nerve function has identified progressive cortical dysfunction in SCA3 patients related to the development of ataxia. SIGNIFICANCE These findings suggest alteration in cortical activity is associated with SCA3 pathogenesis and neurodegeneration.
Collapse
Affiliation(s)
- Michelle A Farrar
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, Australia.
| | - Steve Vucic
- Department of Neurology, Westmead Hospital and Western Clinical School, University of Sydney, Sydney, Australia
| | - Garth Nicholson
- ANZAC Research Institute, University of Sydney, Concord Hospital, New South Wales, Australia
| | - Matthew C Kiernan
- Sydney Medical School, Brain & Mind Centre, University of Sydney, Sydney, Australia
| |
Collapse
|
6
|
Pedroso JL, de Resende Pinto WBV, de Souza PVS, Andriotti C, Stavale JN, Barsottini OG. Anterior horn degeneration in Machado-Joseph disease. J Neurol Sci 2016; 368:290-1. [DOI: 10.1016/j.jns.2016.07.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/04/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
|
7
|
Sun YM, Lu C, Wu ZY. Spinocerebellar ataxia: relationship between phenotype and genotype - a review. Clin Genet 2016; 90:305-14. [PMID: 27220866 DOI: 10.1111/cge.12808] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 05/16/2016] [Accepted: 05/16/2016] [Indexed: 12/12/2022]
Abstract
Spinocerebellar ataxia (SCA) comprises a large group of heterogeneous neurodegenerative disorders inherited in an autosomal dominant fashion. It is characterized by progressive cerebellar ataxia with oculomotor dysfunction, dysarthria, pyramidal signs, extrapyramidal signs, pigmentary retinopathy, peripheral neuropathy, cognitive impairment and other symptoms. It is classified according to the clinical manifestations or genetic nosology. To date, 40 SCAs have been characterized, and include SCA1-40. The pathogenic genes of 28 SCAs were identified. In recent years, with the widespread clinical use of next-generation sequencing, the genes underlying SCAs, and the mutants as well as the affected phenotypes were identified. These advances elucidated the phenotype-genotype relationship in SCAs. We reviewed the recent clinical advances, genetic features and phenotype-genotype correlations involving each SCA and its differentiation. The heterogeneity of the disease and the genetic diagnosis might be attributed to the regional distribution and clinical characteristics. Therefore, recognition of the phenotype-genotype relationship facilitates genetic testing, prognosis and monitoring of symptoms.
Collapse
Affiliation(s)
- Y-M Sun
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - C Lu
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, the Collaborative Innovation Center for Brain Science, Zhejiang University School of Medicine, Hangzhou, China.,Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Z-Y Wu
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, the Collaborative Innovation Center for Brain Science, Zhejiang University School of Medicine, Hangzhou, China. .,Joint Institute for Genetics and Genome Medicine between Zhejiang University and University of Toronto, Zhejiang University, Hangzhou, China.
| |
Collapse
|
8
|
Moro A, Munhoz RP, Arruda WO, Raskin S, Moscovich M, Teive HAG. Spinocerebellar ataxia type 3: subphenotypes in a cohort of Brazilian patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 72:659-62. [PMID: 25252228 DOI: 10.1590/0004-282x20140129] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/08/2014] [Indexed: 12/12/2022]
Abstract
UNLABELLED Spinocerebellar ataxia type 3 (SCA3) involves cerebellar, pyramidal, extrapyramidal, motor neuron and oculomotor systems with strong phenotypic heterogeneity, that lead us to classify the disorder into different clinical subtypes according to the predominantly affected motor systems. METHOD The series comprises 167 SCA3 patients belonging to 68 pedigrees, studied from 1989-2013. These patients were categorized into seven different subphenotypes. RESULTS SCA3 cases were clustered according to the predominant clinical features. Three most common forms were subphenotype 2, characterized by ataxia and pyramidal symptom was observed in 67.5%, subphenotype 3 with ataxia and peripheral signs in 13.3%, and subphenotype 6 with pure cerebellar syndrome in 7.2%. CONCLUSION Our study was the first to systematically classify SCA3 into seven subphenotypes. This classification may be particularly useful for determination of a more specific and direct phenotype/genotype correlation in future studies.
Collapse
Affiliation(s)
- Adriana Moro
- Setor de Neurologia, Departamento de Medicina Interna, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Renato P Munhoz
- Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Walter O Arruda
- Setor de Neurologia, Departamento de Medicina Interna, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Mariana Moscovich
- Setor de Neurologia, Departamento de Medicina Interna, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Hélio A G Teive
- Setor de Neurologia, Departamento de Medicina Interna, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| |
Collapse
|
9
|
Escorcio Bezerra ML, Pedroso JL, Pinheiro DS, Braga-Neto P, Povoas Barsottini OG, Braga NIDO, Manzano GM. Pattern of peripheral nerve involvement in Machado-Joseph disease: neuronopathy or distal axonopathy? A clinical and neurophysiological evaluation. Eur Neurol 2012; 69:129-33. [PMID: 23234876 DOI: 10.1159/000345274] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 09/30/2012] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Neuropathy is a well-recognized feature in spinocerebellar ataxia type 3 (SCA3) or Machado-Joseph disease (MJD), but the pattern of neuropathy is still a matter of debate. This study aimed to evaluate peripheral nerve involvement in MJD patients. Neurophysiological and clinical data were analyzed to distinguish neuronopathy from length-dependent distal axonopathy. METHODS In the present study we evaluated 26 patients with clinical and molecular-proven MJD and investigated their peripheral nerve involvement. Neurophysiological and clinical data were compared and correlated aiming to distinguish neuronopathy from distal axonopathy. RESULTS The neurophysiological evaluation showed that 42.3% of the patients had polyneuropathy. Among these patients, 81.8% presented neuronopathy. CONCLUSION We concluded that neuronopathy is the most common form of peripheral nerve involvement in MJD patients.
Collapse
|
10
|
Gispert S, Kurz A, Waibel S, Bauer P, Liepelt I, Geisen C, Gitler AD, Becker T, Weber M, Berg D, Andersen PM, Krüger R, Riess O, Ludolph AC, Auburger G. The modulation of Amyotrophic Lateral Sclerosis risk by ataxin-2 intermediate polyglutamine expansions is a specific effect. Neurobiol Dis 2011; 45:356-61. [PMID: 21889984 DOI: 10.1016/j.nbd.2011.08.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 08/10/2011] [Accepted: 08/18/2011] [Indexed: 12/13/2022] Open
Abstract
Full expansions of the polyglutamine domain (polyQ≥34) within the polysome-associated protein ataxin-2 (ATXN2) are the cause of a multi-system neurodegenerative disorder, which usually presents as a Spino-Cerebellar Ataxia and is therefore known as SCA2, but may rarely manifest as Levodopa-responsive Parkinson syndrome or as motor neuron disease. Intermediate expansions (27≤polyQ≤33) were reported to modify the risk of Amyotrophic Lateral Sclerosis (ALS). We have now tested the reproducibility and the specificity of this observation. In 559 independent ALS patients from Central Europe, the association of ATXN2 expansions (30≤polyQ≤35) with ALS was highly significant. The study of 1490 patients with Parkinson's disease (PD) showed an enrichment of ATXN2 alleles 27/28 in a subgroup with familial cases, but the overall risk of sporadic PD was unchanged. No association was found between polyQ expansions in Ataxin-3 (ATXN3) and ALS risk. These data indicate a specific interaction between ATXN2 expansions and the causes of ALS, possibly through altered RNA-processing as a common pathogenic factor.
Collapse
Affiliation(s)
- Suzana Gispert
- Experimental Neurology, Goethe University Medical School, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
D'Abreu A, França MC, Yasuda CL, Campos BAG, Lopes-Cendes I, Cendes F. Neocortical atrophy in Machado-Joseph disease: a longitudinal neuroimaging study. J Neuroimaging 2011; 22:285-91. [PMID: 21699609 DOI: 10.1111/j.1552-6569.2011.00614.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/PURPOSE Previous imaging studies in the Machado-Joseph disease (MJD/SCA3) have mostly concentrated on the cerebellum and brainstem. Our goal was to perform a whole brain longitudinal evaluation. METHODS We included 45 patients and 51 controls, who underwent two brain magnetic resonance imaging and magnetic resonance spectroscopy (mean interval of 12.5 ± 1.5 months). We used voxel-based morphometry (VBM) and the MarsBar analysis toolbox to extract grey matter density (GMD) values from regions of interest. We used a linear regression model and a general linear model to correlate GMD with clinical markers, and paired t-test for the longitudinal evaluation. RESULTS We observed decreased GMD (P < .01) at frontal, parietal, temporal and occipital lobes, subcortical grey matter, cerebellum, and brainstem. White matter atrophy was restricted to the cerebellum. Age, CAG, and disease duration predicted GMD in different areas, but age and CAG were the most important predictors. The longitudinal analysis failed to demonstrate changes. Changes in regions other than the cerebellum appeared to contribute significantly to the final International Cooperative Ataxia Rating Scale score. CONCLUSION We confirmed cortical involvement in MJD/SCA3. The most important factors in predicting GMD were age and CAG. The lack of progression of atrophy may indicate floor effect and/or short duration of follow-up.
Collapse
|
12
|
Nanetti L, Fancellu R, Tomasello C, Gellera C, Pareyson D, Mariotti C. Rare association of motor neuron disease and spinocerebellar ataxia type 2 (SCA2): a new case and review of the literature. J Neurol 2009; 256:1926-8. [PMID: 19644730 DOI: 10.1007/s00415-009-5237-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 06/25/2009] [Accepted: 07/01/2009] [Indexed: 12/30/2022]
Abstract
We report a rare association of spinocerebellar ataxia and motor neuron disease (MND) in a woman with genetically confirmed SCA2 who subsequently developed a rapidly progressive and fatal form of MND. Considering the rarity of these two neurological conditions, it is interesting to note that the concomitant occurrence of SCA mutations and MND have been previously observed in three cases: in one patient affected by SCA6 and two other cases with SCA2.
Collapse
|