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The complex clinical and genetic classification of inherited ataxias. I. Dominant ataxias

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Abstract

The clinical classification of autosomal dominant cerebellar ataxias (ADCAs) is intricate due to the variable and unpredictable association of signs and symptoms of central nervous system (CNS) and peripheral nervous system (PNS) deterioration during the life of a patient. However, for many purposes, particularly patient management, clinical systematics is the most useful method for labelling patients; in some instances there is no basis for any more fundamental classification of phenotypes. On the other hand, recent molecular-genetic approaches to dominant ataxias have had a profound impact in nosology, diagnostic procedures and the management of patients, since they are based on the fact that all mendelian neurological diseases can be precisely classified according to the locus involved as well as the particular mutant allele at that locus. Therefore, a clinical and genetic classification of dominant ataxias is herewith proposed as the best nosographical choice. Clinical, neuropathological, genetic, and pathogenetic aspects of ADCAs are reviewed and discussed to help the clinical neurologist guide diagnostic procedures and manage ataxic patients.

Sommario

La classificazione clinica delle atassie cerebellari dominanti autosomiche (ADCA) è intrinsecamente complessa poiché i segni e i sintomi di sofferenza del sistema nervoso centrale e periferico si associano in modo variabile e spesso imprevedibile durante la vita dei pazienti affetti da diverse forme dominanti di atassia. Tuttavia, in assenza di criteri più stringenti per una precisa nosografia, una distinzione semiologica basata sui principali segni clinici è il metodo più utile per un primo inquadramento diagnostico dei malati. Le informazioni di genetica molecolare ottenute recentemente nelle atassie dominanti hanno modificato questa pur utile nosografia, perché portano il contributo di un dato biologico fondamentale consistente nel fatto the ogni malattia ereditaria può essere precisamente classificata sulla base sia del locus genetico coinvolto sia della mutazione eziologicamente responsabile. Sulla base di queste semplici considerazioni si propone una classificazione clinica e genetica delle atassie dominanti. I principali aspetti clinici, neuropatologici, genetici, sono presentati insieme ad una discussione sugli aspetti patogenetici delle ADCA per fornire al neurologo clinico una guida razionale e aggiornata ally diagnosi e alla gestione dei pazienti con atassia.

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Di Donato, S. The complex clinical and genetic classification of inherited ataxias. I. Dominant ataxias. Ital J Neuro Sci 19, 335–343 (1998). https://doi.org/10.1007/BF02341779

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