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From the Department of Neurology and the Department of Physical Medicine and Rehabilitation (Dr. Rantamäki), Seinäjoki Central Hospital, Seinäjoki, Finland; the Division of Human Cancer Genetics (Dr. Krahe), Comprehensive Cancer Center, Ohio State University, Columbus; the Department of Molecular Genetics (Dr. Krahe), Folkhälsan Institute of Genetics, University of Helsinki, Finland; the Department of Pathology (Dr. Paetau), University of Helsinki, Finland; the Department of Molecular Genetics (Dr. Cormand), University of Barcelona, Spain; the Department of Clinical Chemistry and Hematology (Dr. Mononen), Turku University Central Hospital, Finland; the Department of Neurology (Dr. Udd), Vasa Central Hospital, Finland; and Tampere University Hospital (Dr. Udd), Finland.
Address correspondence and reprint requests to Dr. Maria Rantamäki, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; e-mail: maria.rantamaki{at}pp.fimnet.fi
Objective:— To describe an unusual kindred with adult-onset ataxia and thalamic lesions detected by brain MRI.
Methods:— The authors characterized clinical, laboratory, and pathologic features of the disease and sought linkage to previously recognized ataxia loci.
Results:— Two sisters and a brother developed progressive ataxia, dysarthria, mild cognitive impairment, and sensorimotor neuropathy at age 30, combined with epilepsy in one sibling. MRI showed symmetric thalamic lesions, changes in brainstem gray matter, and white matter changes in the cerebellum. Autopsy in one of the patients revealed neuronal degeneration with a peculiar vacuolar change in thalamus, probably representing transsynaptic degeneration in response to deafferentation. Neuronal and secondary tract degeneration was observed in the spinal cord, cerebellum, and brainstem suggesting a spinocerebellar degeneration. The disorder appears to be transmitted as an autosomal recessive trait. Genetic and sequence analysis of the FRDA gene and comprehensive laboratory examinations excluded Friedreich’s ataxia and other similar recessive diseases.
Conclusion:— Adult-onset recessive ataxia with bilateral thalamic lesions in this family may represent a distinct hereditary spinocerebellar ataxia.
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