The wobbly child: an approach to inherited ataxias

Genevieve Bernard1, Michael Shevell

  • 1Department of Neurology/Neurosurgery, McGill University, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.

Insights

Genetic ataxia in children presents diagnostic challenges. This article offers a practical approach to identifying genetic causes of pediatric ataxia, aiding clinical decision-making.

Area of Science:

  • Pediatric Neurology
  • Clinical Genetics
  • Neurogenetics

Background:

  • Genetic causes of ataxia are diverse, complicating diagnosis in pediatric patients.
  • The rapid advancement of molecular diagnostics presents challenges for clinicians in selecting appropriate investigations.
  • Accurate diagnosis is crucial for effective management and genetic counseling in pediatric ataxia.

Observation:

  • Presents three distinct cases of pediatric-onset ataxia with underlying genetic etiologies.
  • Highlights the clinical heterogeneity and diagnostic complexities associated with these genetic disorders.
  • Demonstrates the utility of a structured diagnostic pathway in evaluating children with ataxia.

Findings:

  • Illustrates how a systematic approach can unravel the genetic basis of pediatric ataxia.
  • Emphasizes the importance of integrating clinical findings with molecular diagnostic data.
  • Successfully identified specific genetic mutations responsible for ataxia in the presented cases.

Implications:

  • Provides a practical framework for clinicians managing pediatric ataxia.
  • Aids in the timely and accurate diagnosis of genetic cerebellar ataxias.
  • Facilitates improved patient outcomes through targeted genetic evaluation and management strategies.

Related Concept Videos

Major Somatic Sensory Pathways01:28

Major Somatic Sensory Pathways

Sensory impulses related to touch, pressure, vibration, and proprioception from various body parts, such as the limbs, trunk, neck, and posterior head, travel to the cerebral cortex through the posterior column-medial lemniscus pathway. The pathway’s name derives from the two white-matter tracts that convey the impulses: the spinal cord's posterior column and the brainstem's medial lemniscus. First-order sensory neurons extend their axons into the spinal cord, forming the posterior columns...
Autism Spectrum Disorder01:19

Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by persistent deficits in social communication and interaction alongside restrictive and repetitive behaviors or interests. ASD is sometimes accompanied by intellectual impairment.
These core symptoms manifest differently among individuals, ranging from mild to severe. The disorder's complexity extends beyond its clinical presentation, encompassing a diverse range of biological, cognitive, and sociocultural influences.
Parkinson Disease l: Introduction01:24

Parkinson Disease l: Introduction

Parkinson’s disease is a chronic, progressive neurodegenerative disorder that primarily affects movement. It is characterized by motor symptoms such as resting tremors, muscle rigidity, bradykinesia (slowness of movement), and postural instability. Patients may notice hand tremors at rest, stiffness during movement, or a shuffling gait. In addition to motor features, non-motor symptoms include sleep disturbances, mood and behavioral changes, constipation, and cognitive impairment, all of which...
Huntington Disease l: Introduction01:21

Huntington Disease l: Introduction

Huntington disease or HD is a progressive, fatal neurodegenerative disorder inherited in an autosomal dominant pattern.PathophysiologyIt is caused by expansion of the CAG trinucleotide repeat in the HTT gene on chromosome 4 (4p16.3), producing an abnormal huntingtin protein with an expanded polyglutamine tract. This misfolded protein disrupts cellular function, leading to neuronal death. Normal alleles have ≤26 repeats, 27–35 are intermediate (risk of expansion), 36–39 show reduced penetrance,...
Alterations in Muscle Tone ll01:12

Alterations in Muscle Tone ll

Alterations in muscle tone are common manifestations of neurological disorders and reflect dysfunction within different nervous system regions. Spasticity, paratonia, and dystonia represent distinct forms of hypertonia, each with unique mechanisms, clinical features, and diagnostic importance.CharacteristicsSpasticity happens from upper motor neuron lesions and is characterized by velocity-dependent resistance to passive movement. Clinical features include:Exaggerated deep tendon reflexesClonus...
Disorders of the Skeletal Muscle01:28

Disorders of the Skeletal Muscle

The clinical conditions affecting the skeletal muscle tissue are broadly categorized as musculoskeletal and neuromuscular disorders.
Musculoskeletal disorders
Musculoskeletal disorders involve injuries and conditions affecting the skeletal muscles and associated connective tissues. These disorders can arise from acute biomechanical stresses or chronic overuse and can occur across different age groups. Common injuries include sprains, fractures, and muscular strains, often resulting from...