Spinocerebellar ataxia type 8 - Clinical features in a large family

Objective: To compare the clinical and genetic features of the seven-genera tion family (MN-A) used to define the spinocerebellar ataxia 8 (SCA8) locus . Background: The authors recently described an untranslated CTG expansion that causes a novel form of SCA (SCA8) characterized by reduced penetrance and complex patterns of repeat instability. Methods: Clinical and molecular features of 82 members of the MN-A family were evaluated by neurologic exa mination, quantitative dexterity testing, and, in some individuals, MRI and sperm analyses. Results: SCA8 is a slowly progressive, predominantly cereb ellar ataxia with marked cerebellar atrophy, affecting gait, swallowing, sp eech, and limb and eye movements. CTG; tracts are longer in affected (mean = 116 CTG repeats) than in unaffected expansion carriers (mean = 90, p < 10 (-8)). Quantitative dexterity testing did not detect even subtle signs of a taxia in unaffected expansion carriers. Surprisingly, all 21 affected MN-A family members inherited an expansion from their mothers. The maternal pene trance bias is consistent with maternal repeat expansions yielding alleles above the pathogenic threshold in the family (>107 CTG) and paternal contra ctions resulting in shorter alleles. Consistent with the reduced penetrance of paternal transmissions, CTG tracts in all or nearly all sperm (84 to 99 ) are significantly shorter than in the blood (116) of an affected man. Con clusions: The biologic relationship between repeat length and ataxia indica tes that the CTG repeat is directly involved in SCA8 pathogenesis. Diagnost ic testing and genetic counseling are complicated by the reduced penetrance , which often makes the inheritance appear recessive or sporadic, and by in terfamilial differences in the length of a stable (CTA)(n) bact preceding t he CTG repeat.