Sirs,Ataxia with oculomotor apraxia type 2 (AOA2) is anautosomal recessive cerebellar ataxia associated withmutations in the senataxin (SETX) gene coding for theortholog of a yeast DNA/RNA helicase [7]. The disorder ischaracterized by adolescent age at onset, spinocerebellargait ataxia, cerebellar atrophy, peripheral sensorimotorneuropathy, areflexia, elevated a-fetoprotein, saccadicocular pursuit, and occasionally oculomotor apraxia. Mildcognitive impairment, involuntary movements, c-globulin,and creatine phosphokinase elevation may also occur [1–7]. Here we report the documented course over 27 years ofa case of AOA2 and a novel homozygous stop mutationp.R1778X in the SETX gene.This 47-year-old woman was born to consanguineousparents (first cousins). After normal delivery and childhoodshe first noticed gait problems at the age of 15 years.Unsteadiness gradually worsened and she has essentiallybeen wheelchair-bound from the age of 30. Mild mental andpsychomotor decline became evident after graduating fromjunior high school at age 16. Severe myopia evolved fromthe age of 8. As reported in other AOA2 cases [2, 5, 6],this patient developed secondary amenorrhoea in earlyadulthood,indicating animportant roleofsenataxin notonlyin neuron survival but also in germ line cell survival [2].The patient was examined in our institute at age 20(1981) and at age 47 (2008). On both occasions, mildcognitive impairment was obvious. Dysarthria was ratedmild at age 20, and moderate at age 47. Eye movementswere full with marked saccadic pursuit at both dates, andthere was no oculomotor apraxia. There were no muscleweakness or foot deformities. Deep tendon reflexes werenormal at age 20 but absent at age 47. There was noextensor plantar response. Vibration and position senseswere not documented at age 20 but impaired in her upperand absent in her lower extremities at age 47. Touch sen-sation was normal. Finger-to-nose and heel-to-shin testingwas mildly dysmetric at age 20 and 47 without majorprogression. Choreic movements were apparent in 1977and a severe kinetic tremor described in 1981 decreasedover the course of the disease. At age 20, her gait waswide-based and Romberg’s sign was positive. At age 47,our patient presented with severe gait ataxia and standinginstability, and was confined to a wheelchair.At age 20, electromyography (EMG) and muscle biopsyfrom tibialis anterior muscle showed severe neurogenicchanges while nerve conduction velocity (NCV) wasspared (peroneal nerve: 42 m/s). At age 47, neurophysio-logical testing revealed a sensorimotor neuropathy. EMGshowed chronic neurogenic remodelling with single motorunit discharge patterns, pathologic spontaneous activity,and pseudomyotonic discharges. Median nerve showedprolonged distal latency (6.0 ms), and reduced NCV(33.4 m/s) and amplitude (1.9 mV). Sensory NCV was notreproducible in the radial, median, and ulnar nerves. BrainCT at age 47 revealed severe cerebellar atrophy affectingpredominantly the vermis (Fig. 1). Her general physicaland gynaecological examination was unremarkable without