Slowly progressive cerebellar ataxia and cervical dystonia: Clinical presentation of a new form of spinocerebellar ataxia?

Authors

  • Mikko Kuoppamäki MD,

    1. National Hospital for Neurology and Neurosurgery, Institute of Neurology, Queen Square, London, United Kingdom
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  • Paula Giunti MD,

    1. Department of Molecular Pathogenetics, Institute of Neurology, London, United Kingdom
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  • Niall Quinn FRCP,

    1. National Hospital for Neurology and Neurosurgery, Institute of Neurology, Queen Square, London, United Kingdom
    2. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, University College London, London, United Kingdom
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  • Nicholas W. Wood FRCP,

    1. National Hospital for Neurology and Neurosurgery, Institute of Neurology, Queen Square, London, United Kingdom
    2. Department of Molecular Pathogenetics, Institute of Neurology, London, United Kingdom
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  • Kailash P. Bhatia FRCP

    Corresponding author
    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, University College London, London, United Kingdom
    • Reader in Clinical Neurology, Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
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  • A videotape accompanies this article.

Abstract

We describe 5 cases with a rare combination of young-onset, slowly progressive cerebellar ataxia and cervical dystonia. Two were sporadic, whereas the other 3 were familial, including 2 from one family. The age of onset of these cases was between 16 and 37 years. The presenting symptom was cervical dystonia and/or dystonic head tremor in 3 patients and hand or lower limb tremor in 2. In 2 cases, cervical dystonia and/or dystonic head tremor developed approximately 6 to 10 years before cerebellar dysfunction, and in three they developed at the same time. Apart from cervical dystonia, there was mild dystonic limb involvement in 2 cases, but generalized dystonia was not seen. Cerebellar ataxia was slowly progressive. A literature search showed 10 cases of cervical dystonia associated with genetically undetermined (n = 5) or genetically proven (n = 5) spinocerebellar ataxia (SCA). When the genotype was known, these patients had either SCA3, 6, 7, or 12. However, our 5 cases (or their first-degree relatives) tested negative for SCA1, 2, 3, 6, and 7, and in the 4 cases (or their first-degree relatives) tested for SCA12, the result was negative. We propose that this rare phenotype manifesting as a combination of cerebellar ataxia and cervical dystonia may represent one or more new, as yet uncharacterized, genotypes of inherited young-onset spinocerebellar ataxia. © Movement Disorder Society

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