Abstract
BackgroundSpinocerebellar ataxia (SCA) presents with variable clinical presentations in addition to ataxia. The aim of this study was to reappraise the diverse nonataxic clinical characteristics of the five most common SCA subtypes in the Asian population.MethodsThe clinical presentations of 90 patients with genetically confirmed SCA1, SCA2, SCA3, SCA6, or SCA17 were assessed retrospectively between November 2008 and September 2018 at a tertiary referral center in Taiwan.ResultsParkinsonism was the most common nonataxic phenotype (21.1%), with a greater prevalence than Caucasian and other Asian SCA carriers. Patients with parkinsonism feature had fewer CAG repeats in SCA2 (31.0 ± 4.5 vs. 36.9 ± 6.0, p = .03) and SCA3 (65.6 ± 7.9 vs. 70.0 ± 4.2, p = .02) compared to those with pure ataxia presentation. The average age of symptom onset was significantly higher in the parkinsonism group of SCA2 (51.5 ± 8.9 vs. 35.3 ± 12.6 years, p = .007) than those with pure ataxia. Focal or segmental dystonia was identified in 4.4% of SCA patients (n = 2 each SCA2 and SCA3). Nonmotor symptoms, including impaired cognition (6.1% of SCA2 and 8.3% of SCA3 patients) and depression (9.1% of SCA2 and 8.3% of SCA3 patients), were also common nonataxic features in our SCA patients.ConclusionsParkinsonism, dystonia, and cognitive‐psychiatric symptoms are common features in patients with SCA mutations in our population. Our study identifies a different clinical spectrum of SCA1, SCA2, SCA3, SCA6, and SCA17 compared to Caucasians.
Highlights
Spinocerebellar ataxia (SCA) is a group of autosomal dominant hereditary cerebellar disorders with heterogeneous phenotypes (Sullivan, Yau, O'Connor, & Houlden, 2018)
We report the clinical spectrum of patients with different subtypes of SCA in Taiwan
Patients with a combined parkinsonism feature had fewer CAG repeats in SCA2 and SCA3 than patients presenting with ataxia only
Summary
Spinocerebellar ataxia (SCA) is a group of autosomal dominant hereditary cerebellar disorders with heterogeneous phenotypes (Sullivan, Yau, O'Connor, & Houlden, 2018). Features of movement disorders are among the most common co‐ existing nonataxic symptoms in SCA, especially SCA3 (Garcia Ruiz, Mayo, Hernandez, Cantarero, & Ayuso, 2002; Schols et al, 2000) These nonataxic clinical presentations have been reported to predict clinical progression and prognosis (Kuo et al, 2017; Monte et al, 2017). SCA10 is frequently associated with epilepsy in Mexicans but manifests as pure cerebellar ataxia in Brazilians (Teive et al, 2011) These heterogeneous clinical manifestations are mainly attributed to the length of nucleotide repeats and presence of interrupted expansion affecting mRNA transcription and translation (McFarland et al, 2014; Rossi, Perez‐Lloret, Doldan, et al, 2014), other undefined genetic modifiers may affect the phenotype of SCA. We aimed to reappraise the diverse nonataxic clinical characteristics of the five most common SCA subtypes in the East Asian population and to compare them with other ethnic groups
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