CONSEQUENCES OF THE DELAYED DIAGNOSIS OF ATAXIA-TELANGIECTASIA

Objectives. Ataxia-telangiectasia (AT) is a rare, autosomal recessive neurodegenerative disorder in which the diagnosis is obvious when atax ia and telangiectasia are both present. However, the diagnosis can be made upon the onset of ataxia and before the appearance of telangiecta sia if confirmed by laboratory tests. Early diagnosis is important for genetic counseling, appropriate care, and avoidance of unnecessary te sts. The purpose of this study is to identify factors responsible for delays in the diagnosis of AT. Design. The records of all patients see n at the Ataxia-Telangiectasia Clinical Center from July 1, 1995 to Ap ril 1, 1997 were reviewed to determine age of onset of gait abnormalit y, recognition of telangiectasia, and diagnosis. Results. In 48 patien ts with AT, who were the index cases in their respective families, the median age of diagnosis (78 months) occurred after the onset of gait abnormalities (15 months) and closely corresponded to the development of telangiectasia (72 months). In the majority of cases (34/48), telan giectasia appeared before the diagnosis was established. The most comm on misdiagnosis was cerebral palsy (29/48 cases). Twenty-one children (4 with AT) were born after the start of symptoms in the index case, b ut before the establishment of a diagnosis. Conclusions. The term AT, although a concise and memorable label for the disorder, is also a bar rier to early diagnosis. We recommend the use of routine serum cx-feto protein testing for all children with persistent ataxia.