U.S. flag

An official website of the United States government

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2024.

Cover of GeneReviews®

GeneReviews® [Internet].

Show details

Spinocerebellar Ataxia Type 3

Synonyms: Machado-Joseph Disease, SCA3

, MD, PhD and , MD, PhD.

Author Information and Affiliations

Initial Posting: ; Last Update: June 4, 2020.

Estimated reading time: 31 minutes


Clinical characteristics.

Spinocerebellar ataxia type 3 (SCA3), also known as Machado-Joseph disease (MJD), is characterized by progressive cerebellar ataxia and variable findings including pyramidal signs, a dystonic-rigid extrapyramidal syndrome, significant peripheral amyotrophy and generalized areflexia, progressive external ophthalmoplegia, action-induced facial and lingual fasciculations, and bulging eyes. Neurologic findings tend to evolve as the disorder progresses.


The diagnosis of SCA3 is established in a proband with suggestive findings and a heterozygous abnormal CAG trinucleotide repeat expansion in ATXN3 identified by molecular genetic testing.


Treatment of manifestations: Management is supportive as no medication slows the course of disease. The goals of treatment are to maximize function and reduce complications. It is recommended that each individual be managed by a multidisciplinary team of relevant specialists such as neurologists, occupational therapists, physical therapists, physiatrists, orthopedists, nutritionists, speech therapists, social workers, and psychologists. Various manifestations may respond to pharmacologic agents. Regular physical activity is recommended, including combined physical and occupational therapy focused on gait and coordination. Canes and walkers help prevent falling; motorized scooters, weighted eating utensils, and dressing hooks help to maintain independence. Speech therapy and communication devices may benefit those with dysarthria, and dietary modification those with dysphagia. Other recommendations include home adaptations to prevent falls and improve mobility, dietary supplements if caloric intake is reduced, weight control to facilitate ambulation and mobility, and caution with general anesthesia.

Surveillance: Annual assessments (or more frequently as needed) of neurologic findings (e.g., dysarthria, dysphagia, bladder dysfunction, neuropathic pain, cognitive and psychiatric manifestations), weight and nutritional status, and social support.

Genetic counseling.

SCA3 is inherited in an autosomal dominant manner. Each child of an affected individual has a 50% chance of inheriting the ATXN3 CAG repeat expansion.

Once the CAG repeat expansion has been identified in an affected family member, prenatal testing for a pregnancy at increased risk and preimplantation genetic testing are possible. Note: The prenatal finding of an ATXN3 CAG repeat expansion cannot be used to accurately predict onset, severity, type of symptoms, or rate of progression of SCA3.


Suggestive Findings

Spinocerebellar ataxia type 3 (SCA3), also known as Machado-Joseph disease (MJD), should be suspected in individuals with the following clinical findings and family history [Lima & Coutinho 1980, D'Abreu et al 2010].

Clinical findings. Progressive cerebellar ataxia often and variably associated with:

  • Pyramidal signs
  • A dystonic-rigid extrapyramidal syndrome
  • Significant peripheral amyotrophy and generalized areflexia
  • Progressive external ophthalmoplegia
  • Action-induced facial and lingual fasciculations; bulging eyes

Family history. Consistent with autosomal dominant inheritance (i.e., multiple affected family members in successive generations or a single occurrence in a family). Absence of a family history of SCA3 does not preclude this diagnosis.

Establishing the Diagnosis

The diagnosis of SCA3 is established in a proband with suggestive findings and a heterozygous abnormal CAG trinucleotide repeat expansion in ATXN3 identified by molecular genetic testing (see Table 1).

Note: Pathogenic (CAG)n repeat expansions in ATXN3 cannot be detected by sequence-based multigene panels, exome sequencing, or genome sequencing.

Repeat sizes [Costa Mdo & Paulson 2012 and references therein]:

Molecular genetic testing relies on targeted analysis to characterize the number of ATXN3 CAG repeats (see Table 7).

Table 1.

Molecular Genetic Testing Used in Spinocerebellar Ataxia Type 3

Gene 1Method 2, 3Proportion of Probands with a Pathogenic Variant Detectable by Method
ATXN3 Targeted analysis for CAG trinucleotide expansions100%

See Table 7 for specific methods to characterize the number of CAG repeats in ATXN3.


Note: Sequence-based multigene panels, exome sequencing, and genome sequencing cannot detect pathogenic repeat expansions in this gene.

Clinical Characteristics

Clinical Description

Spinocerebellar ataxia type 3 (SCA3) is characterized by progressive cerebellar ataxia and variable findings including pyramidal signs, a dystonic-rigid extrapyramidal syndrome, significant peripheral amyotrophy and generalized areflexia, progressive external ophthalmoplegia, action-induced facial and lingual fasciculations, and bulging eyes. Neurologic findings tend to evolve as the disorder progresses.

Table 2.

Select Features of Spinocerebellar Ataxia Type 3

Nearly allCommonInfrequent
Cerebellar ataxia Limb & gait ataxia
Dysarthria Cerebellar & hypokinetic dysarthria
Ophthalmologic involvement Nystagmus; slow saccadic eye movements; ophthalmoparesis, dysconjugate eye movements, & diplopia
Vestibular dysfunction Early sign of disease, noted on head turning
Motor neuron degeneration
  • Upper motor neuron involvement (hyperreflexia, spasticity) may resemble HSP.
  • Lower motor neuron involvement (fasciculations, weakness w/muscle wasting, areflexia, distal sensory loss)
Cognitive difficulties
footnote 1.
Cerebellar cognitive affective syndrome may incl impairments in executive functioning, visual processing, & some forms of memory.
Mood changes Impaired emotional functioning; depression
Dystonia Dystonia more common in early-onset disease
  • Rigidity is a more reliable indicator than tremor or bradykinesia.
  • Parkinsonism is often DOPA responsive.
Autonomic dysfunction Bladder disturbances, difficulty w/thermoregulation, & cardiovascular dysautonomia
Sleep disorder Rapid eye movement behavior disorder; periodic limb movements
Restless legs syndrome
Fatigue Assoc w/depression & daytime somnolence
Behavior disorder
Chronic pain Most often lumbosacral
Respiratory involvement Terminal disease

HSP = hereditary spastic paraplegia


Major cognitive decline is infrequent.

Age of onset of SCA3 is highly variable but most commonly in the second to fifth decade. In a large cohort of affected individuals from the Azores, the mean onset was age 37 years. The range of age of onset largely reflects differences in CAG repeat size (see Genotype-Phenotype Correlations) and the specific clinical features can vary greatly, depending largely on CAG repeat length and age of onset [Cancel et al 1995, Maciel et al 1995, Matilla et al 1995, Dürr et al 1996, Matsumura et al 1996, Schöls et al 1996, Vale et al 2010].

Presenting features include gait problems, speech difficulties, clumsiness, and vestibular and oculomotor findings (for review see Mendonça et al [2018], Klockgether et al [2019], and references therein; see also Yoshizawa et al [2004], Rana et al [2016], Wolf et al [2017], and Wu et al [2017]).

Progressive ataxia, nystagmus, diplopia, dysarthria, and hyperreflexia may occur early in the disease. An early sign can be a feeling of unsteadiness on head turning, indicating vestibular dysfunction. Subtle balance issues usually predate hand incoordination.

Upper motor neuron signs often become prominent, and in some families may resemble hereditary spastic paraplegia [Gan et al 2009, Wang et al 2009, Lin et al 2018].

Earlier-onset disease (before age ~25 years) often manifests dystonia [Nunes et al 2015], whereas later-onset disease (after age ~50 years) often manifests peripheral neuropathy and amyotrophy.

SCA3 should also be considered in cases of familial Parkinsonism, especially in individuals with African ancestry [Subramony et al 2002, Lu et al 2004].

Other findings may include the following:

Disease progression

  • Ambulation becomes increasingly difficult, leading to the need for assistive devices (including wheelchair) ten to 15 years following onset.
  • Profound ataxia of limbs and gait becomes prominent. Individuals with later adult onset and shorter CAG repeats can manifest a disorder that combines ataxia, generalized areflexia, peripheral neuropathy, and muscle wasting.
  • Saccadic eye movements become slow and ophthalmoparesis develops, resulting initially in upgaze restriction. Dysconjugate eye movements result in diplopia.
  • At the same time, a number of other "brain stem" signs develop, including temporal and facial atrophy, characteristic action-induced perioral twitches, vestibular symptoms, tongue atrophy and fasciculations, dysphagia, and poor ability to cough and clear secretions.
  • Often a staring appearance to the eyes is observed, but neither this nor the perioral fasciculations are specific for SCA3.
  • Evidence of a peripheral polyneuropathy [França et al 2009] may appear later, with loss of distal sensation, ankle reflexes, and sometimes other reflexes as well, and with some degree of muscle wasting.
  • Parkinsonism that can respond to dopaminergic agents (e.g., levodopa) occurs in a subset of individuals.
  • Sitting posture is compromised later in disease, with affected individuals assuming various tilted positions.
  • Autonomic dysfunction can sometimes be disabling, but is not always related to severity of motor dysfunction or disease duration.

Late in the disease course, individuals are usually wheelchair bound and have severe dysarthria, dysphagia, facial and temporal atrophy, poor cough, often dystonic posturing and ophthalmoparesis, and occasionally blepharospasm.

Life span. The disease progresses relentlessly; death from pulmonary complications and cachexia occurs from six to 29 years after onset [Sudarsky et al 1992, Sequeiros & Coutinho 1993]. In a study from Brazil, the mean age of onset was 36 years with a 21-year mean survival after onset [Kieling et al 2007].

Subtypes of SCA3. Clinical features can vary greatly, due largely to varying CAG repeat size. Based on this phenotypic variability, Portuguese researchers classified SCA3 into several subtypes in addition to ataxia, including a dystonic-rigid syndrome, a parkinsonian syndrome, and a neuronal amyotrophy syndrome with muscle wasting and peripheral neuropathy [Riess et al 2008]. However, striving to place affected individuals into a specific SCA3 subtype has little clinical value because of the considerable overlap across subtypes, and because one type can evolve into another during the course of disease [Fowler 1984].

Brain MRI most often reveals pontocerebellar atrophy [Bürk et al 1996]. The most commonly observed abnormality is enlargement of the fourth ventricle [Onodera et al 1998], which reflects atrophy of the cerebellum and brain stem. The degree of brain atrophy detectable by MRI varies greatly, consistent with the wide clinical variability observed. In a large European natural history study, clinical dysfunction in SCA3 correlated with the degree of total brain stem atrophy [Schulz et al 2010].

Brain magnetic resonance spectroscopy (MRS) can detect early neurochemical abnormalities in brain regions of SCA3 and similar SCAs [Joers et al 2018]. Efforts are under way to determine whether MRS in select brain regions can be used in clinical trials as an early biomarker of disease state or progression [Ashizawa et al 2018].

Nerve conduction velocity studies often reveal involvement of sensory nerves as well as motor neurons [Lin & Soong 2002, França et al 2009].

Neuropathologic studies have established that degeneration is widespread and not confined to the cerebellum, brain stem, and basal ganglia [Rüb et al 2008]. In general, however, the cerebral cortex is largely spared despite evidence of cognitive dysfunction. While the cerebellum typically shows atrophy (particularly of the deep cerebellar nuclei) in some individuals, Purkinje cells and inferior olivary neurons are relatively spared [Sequeiros & Coutinho 1993].

Genotype-Phenotype Correlations

Age of onset inversely correlates with the size of the CAG repeat expansion. Some individuals with the largest reported expansions (86 and 83 repeats) had disease onset at age five years and 11 years, respectively [Zhou et al 1997]. Despite such observations, there is evidence that other nonspecified genetic or non-genetic factors also contribute [van de Warrenburg et al 2005, Globas et al 2008].

Phenotype. A loose correlation exists between the size of the CAG repeat expansion and the clinical phenotype [Cancel et al 1995, Maciel et al 1995, Matilla et al 1995, Sasaki et al 1995, Dürr et al 1996, Lerer et al 1996, Matsumura et al 1996, Schöls et al 1996, Vale et al 2010].

In general, the longest disease-causing CAG repeats cause earlier-onset disease that is more likely to have dystonia as part of the presentation.

In contrast, the shortest disease-causing CAG repeats cause later-onset disease that is more likely to have peripheral manifestations such as neuropathy and weakness. Parkinsonism, which occurs in a subset of affected persons, is not associated with any particular CAG repeat size. Rare intermediate alleles of 45 to about 60 CAG repeats may show variable expressivity; in particular, these rare intermediate alleles can manifest with isolated restless legs syndrome with no other features of disease.

Intrafamilial variation in severity has been reported [Lerer et al 1996, Carvalho et al 2008]. Variation in severity is largely attributed to differences in CAG repeat size.

Homozygosity for the CAG repeat has been associated with more severe disease in a few families [Lerer et al 1996, Carvalho et al 2008]. However, many homozygotes in a Yemeni family were no more severely affected than heterozygotes in other families.


In SCA3, penetrance approaches 100% and is age related.

CAG repeat sizes associated with reduced penetrance of SCA3 are not firmly defined. Of note, an asymptomatic individual age 66 years with 68 CAGs has been reported [van Alfen et al 2001].


Instability of the CAG repeat expansion has been documented in transmission of the repeat from parent to child. Overall, expansion of the repeat is more common than contraction; thus, anticipation (earlier age of onset and more severe disease manifestations in offspring) occurs in SCA3.

Although the probability of CAG repeat expansion may be greater with paternal than with maternal transmission, the paternal bias is not pronounced (as, for example, in Huntington disease) [Souza et al 2016].


SCA3 is also known as Machado-Joseph disease (MJD) and Azorean ataxia. In fact, this autosomal dominant form of ataxia, which was first described among immigrants from the Portuguese Azorean islands, was initially known as MJD. In the early 1990s the locus for MJD was identified on chromosome 14 and revealed to be a CAG repeat expansion in MJD1 (now renamed ATXN3). During this same time, scientists mapped what was initially thought to be an unrelated ataxia, SCA3, to the same chromosomal region. Once the ATXN3 CAG repeat expansion underlying MJD was discovered, it soon became clear that SCA3 and MJD were caused by CAG repeat expansions in the same gene.


No accurate data are available regarding the prevalence of SCA3 in the general population, though in many populations SCA3 is the most common of the autosomal dominant ataxias, which overall are rare.

Worldwide, SCA3 is thought to be the most common spinocerebellar ataxia (SCA), comprising 20%-50% of families (reviewed in Klockgether et al [2019]).

Countries in which SCA3 is the most common SCA include Portugal (58%-74%), Brazil (69%-92%), China (48%-49%), the Netherlands (44%), Germany (42%), and Japan (28%-63%).

In contrast, countries in which SCA3 is quite rare include Italy (1%) and South Africa (4%) [Klockgether et al 2019 and references therein].

In the US and Canada, SCA3 is one of several SCAs comprising the most common autosomal dominant ataxias, with SCA3 accounting for 21%-25% of families [Klockgether et al 2019 and references therein].

Origin of the CAG repeat expansion. Haplotype analyses suggest that the CAG repeat expansion arose independently from at least two distinct events, the first occurring in Asia and the second in the Portuguese population [Gaspar et al 1996, Martins et al 2007, Klockgether et al 2019 and references therein]. Most disease worldwide likely resulted from Portuguese emigration.

A large international genetic study showed that a single intragenic haplotype is shared by a majority of the families studied (including those from the Azorean island of Flores), suggesting a single founder variant. However, at least two other haplotypes have been identified in the Portuguese population [Gaspar et al 2001, Verbeek et al 2004].

Differential Diagnosis

Individuals with spinocerebellar ataxia type 3 (SCA3) may present with unexplained ataxia that is part of the larger differential diagnosis of hereditary and acquired ataxias (see Hereditary Ataxia Overview).

Progressive ataxia, often associated with evidence of upper motor neuron dysfunction including brisk tendon reflexes and extensor plantar responses, can be seen in individuals with SCA3 as well as in many other dominantly inherited ataxias. Thus, it is difficult and often impossible to distinguish SCA3 from the other hereditary ataxias (see Hereditary Ataxia Overview).

The presence of dystonia and parkinsonian features, including a beneficial response to levodopa or dopamine agonists, can cause diagnostic confusion with dopa-responsive dystonia and Parkinson disease [Schöls et al 2000]. In SCA3, however, most individuals manifesting with parkinsonian features also have some evidence of cerebellar involvement.


Evaluations Following Initial Diagnosis

To establish the extent of disease and needs in an individual diagnosed with spinocerebellar ataxia type 3 (SCA3), the evaluations summarized in Table 3 (if not performed as part of the evaluation that led to the diagnosis) are recommended.

Table 3.

Recommended Evaluations Following Initial Diagnosis in Individuals with Spinocerebellar Ataxia Type 3

Neurologic Neurologist assess for cerebellar motor dysfunction (gait & postural ataxia, dysmetria, dysdiadochokinesis, tremor, dysarthria, nystagmus, saccades & smooth pursuit)Use standardized scale to establish baseline for ataxia (SARA, ICARS, or BARS). 1
UMN &/or LMN dysfunction (weakness, spasticity, Babinski signs, hyperreflexia, amyotrophy, fasciculations)
  • Brain MRI &/or spinal cord MRI may be indicated to rule out coincident pathologies.
  • Consider referral to neuromuscular clinic.
Extrapyramidal features (e.g., dystonia, parkinsonism)
Consider referral to OT/PT / rehab specialist.To assess gross motor & fine motor skills, gait, ambulation, need for adaptive devices, PT/OT
Eyes Complete eye exam
  • Assess best corrected visual acuity; nystagmus, saccades & smooth pursuit; vertical & horizontal gaze limitation; ptosis.
  • Consider referral to ophthalmologist for corrective measures incl prisms &/or surgery.
Speech For those w/dysarthria: speech/language evalConsider referral to speech/language pathologist.
Feeding For those w/frequent choking or severe dysphagia, assess:
  • Nutritional status;
  • Aspiration risk.
Consider involving a gastroenterology / nutrition / feeding team, incl formal swallowing eval.
Respiratory For those w/respiratory symptoms or muscular involvement: obtain pulmonary function tests.Consider involving pulmonary specialist / respiratory therapist.
History of difficulty w/thermoregulation, syncope
Bladder function History of spastic bladder symptoms: urgency, frequency, difficulty voidingReferral to urologist; consider urodynamic eval.
Sleep issues Consider sleep study.For obstructive sleep apnea
Chronic pain Assess location, relationship to sleep or body position, & association w/neuropathy or dystonia.Depending on location & nature of pain, consider EMG or regional MRI to assess cause.
Assess for cognitive dysfunction assoc w/cerebellar cognitive affective syndrome (executive function, language processing, visuospatial/visuoconstructional skills, emotion regulation).Consider use of:
  • CCAS scale 2 to evaluate cognitive & emotional involvement;
  • Psychiatrist, psychologist, or neuropsychologist if needed.
By genetics professionals 3To inform affected individuals & their families re nature, MOI, & implications of SCA3 to facilitate medical & personal decision making
Family support
& resources
Assess need for:
  • Community or online resources;
  • Social work involvement for parental support;
  • Home nursing referral.

BARS = Brief Ataxia Rating Scale; CCAS = cerebellar cognitive affective syndrome; ICARS = International Cooperative Ataxia Rating Scale; LMN = lower motor neuron; MOI = mode of inheritance; OT = occupational therapy; PT = physical therapy; SARA = Scale for the Assessment and Rating of Ataxia; UMN = upper motor neuron


Medical geneticist, certified genetic counselor, certified advanced genetic nurse

Treatment of Manifestations

There is no specific treatment for SCA3. The goals of treatment are to maximize function and reduce complications. Each individual should be managed by a multidisciplinary team of relevant specialists such as neurologists, occupational therapists, physical therapists, physiatrists, orthopedists, nutritionists, speech therapists, social workers, and psychologists depending on the clinical manifestations.

Management remains supportive as no medication has been proven to slow the course of disease, Excellent reviews include D'Abreu et al [2010], Ashizawa et al [2018], Duarte-Silva & Maciel [2018], Zesiewicz et al [2018], and Klockgether et al [2019].

Table 4.

Treatment of Manifestations in Individuals with Spinocerebellar Ataxia Type 3

Cerebellar ataxia
  • PT & OT
  • Self-directed exercise
  • PT (balance exercises, gait training, muscle strengthening) to maintain mobility & function 1
  • OT to optimize ADL, incl use of adaptive devices (e.g., weighted eating utensils, dressing hooks)
  • Consider adaptive devices to maintain/improve independence in mobility (e.g., canes, walkers, motorized chairs).
  • Inpatient rehab w/OT/PT may improve ataxia & functional abilities in patents w/degenerative ataxias. 2, 3
  • Weight control to avoid obesity
  • Home adaptations to prevent falls (e.g., grab bars, raised toilet seats) & improve mobility (e.g., ramps to accommodate motorized chairs)
  • Although neither exercise nor PT slows progression of incoordination or muscle weakness, affected individuals should maintain activity.
Pharmacologic treatmentRiluzole 2, 4 & valproic acid 2 may be beneficial for ataxia, though not proven in SCA3 clinical trials.
Transcranial magnetic stimulation
Upper motor neuron
Pharmacologic treatment
  • Oral antispasmodics (baclofen, atropine-like drugs, & hypnotic agents) may yield variable response.
  • Botulinum toxin 5 or intrathecal baclofen should also be considered.
Lower motor neuron
involvement (weakness)
Dystonia Pharmacologic treatment
  • Antispasmodic agents (e.g., anticholinergics, baclofen) or botulinum toxin injections 5
  • For generalized dystonia, consider pallidal deep brain stimulation.
Parkinsonism Pharmacologic treatmentLevodopa or dopamine agonist 6
Ophthalmologist referral
  • Prisms
  • Corrective surgery for strabismus
  • Although 4-aminopyridine can ↓ downbeat nystagmus, horizontal nystagmus is much more common in SCA3.
Dysarthria Speech/language therapyConsider alternative communication methods as needed (e.g., writing pads, digital devices).
Dysphagia Feeding therapy programs to improve nutrition & dysphagia & ↓ aspiration risk
  • Video esophagram may help define best food consistency.
  • Education re strategies to mitigate aspiration
Drooling Baclofen, atropine-like drugs
Weight Nutrition assessment
  • Consider nutritional & vitamin supplementation to meet dietary needs.
  • Avoid obesity, which can exacerbate difficulties w/ambulation & mobility.
Respiratory General anesthesia may be problematic; experience w/local anesthesia has been reported [Teo et al 2004].
Sleep issues REM sleep behavior disorderMelatonin
Nocturnal crampsStretching exercises, B complex vitamins, verapamil, diltiazem, gabapentin
Obstructive sleep apneaDocument & treat obstructive sleep apnea.
Fatigue Daytime fatigue may respond to psychostimulants used in narcolepsy (e.g., modafinil); consider sleep study to rule out sleep disorder.
Orthostatic hypotension is not common, but if present consider support hose or, as needed, oral agents (e.g., fludrocortisone).
  • Oral agents for bladder spasticity (anticholinergics, mirabegron)
  • Percutaneous tibial nerve stimulation
Restless legs syndrome
& periodic limb
movements of sleep
  • Iron replacement if deficient
  • Levodopa or dopamine agonist 5
Chronic pain If present, neuropathic pain can be treated w/standard pharmacologic therapies.
Cognitive/Psychiatric Pharmacologic treatmentStandard treatment for psychiatric manifestations (e.g., depression, anxiety, psychosis) 7
Psychotherapy / neuropsychological rehabilitationConsider cognitive & behavioral therapy, incl Goal Management Training®8, 9
Social support Social work referralReferral to assist in identifying sources for in-home or local community support

ADL = activities of daily living; OT = occupational therapy/therapist; PT = physical therapy/therapist; REM = rapid eye movement


Depression scores improved as a consequence of occupational therapy, underscoring the fact that non-pharmacologic measures may also improve affective disorder in SCA3 [Silva et al 2010].



Table 5.

Recommended Surveillance for Individuals with Spinocerebellar Ataxia Type 3

  • Neurologic assessment for progression of ataxia; UMN or LMN signs; dystonia & parkinsonism; autonomic dysfunction
  • Monitor ataxia progression w/standardized scale (SARA, ICARS, or BARS). 1
Annually; more often for an acute exacerbation
Physiatry, OT/PT assessment of mobility, self-help skills as they relate to ataxia, spasticity, weaknessAnnually; more often for an acute exacerbation
Dysarthria Need for alternative communication method or speech therapyPer symptom progression
Dysphagia Assess aspiration risk & feeding methods.Per symptom progression
Weight / Nutritional
  • Monitor BMI.
  • Consult a nutritionist.
  • High-calorie supplementation
Respiratory If symptoms, pulmonary function testsPer symptom progression
Bladder dysfunction Flow studies & eval by urologistPer symptom progression
Neuropathic pain Evaluate need for pharmacologic treatment.Per symptom progression
Evaluate mood, signs of psychosis, cognitive complaints to identify need for pharmacologic & psychotherapeutic interventions.Per symptom progression & development of psychiatric symptoms
Social support Assess needs of affected person & caregiver.Annually

BARS = Brief Ataxia Rating Scale; ICARS = International Co-operative Ataxia Rating Scale; LMN = lower motor neuron; OT = occupational therapy; PT = physical therapy; SARA = Scale for the Assessment and Rating of Ataxia; UMN = upper motor neuron


Evaluation of Relatives at Risk

See Genetic Counseling for issues related to testing of at-risk relatives for genetic counseling purposes.

Therapies Under Investigation

Currently, no medication has been proven to slow or halt the progression of SCA3. The recent promise of nucleotide-based gene silencing strategies in other neurodegenerative diseases such as spinal muscular atrophy, coupled with preclinical success of gene silencing therapy in mouse models of SCA3 [McLoughlin et al 2018], suggest that similar nucleotide-based gene silencing strategies for SCA3 may soon be tested in human clinical trials.

Ataxia investigators in Europe and in the United States are currently engaged in a collaborative grant application for trial readiness for SCA3 (READISCA) that is seeking to define the natural history of SCA3 and appropriate disease biomarkers [Ashizawa et al 2018].

Troriluzole, a prodrug (i.e., a biologically inactive compound that can be metabolized in the body to produce a drug) of riluzole, is currently being tested as a potential symptomatic treatment for ataxia in several spinocerebellar ataxias including SCA3.

Potassium ion channel modulators have been shown to have symptomatic benefit in animal models of several spinocerebellar ataxias [Bushart et al 2018], but have not yet been evaluated in clinical trials.

Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for access to information on clinical studies for a wide range of diseases and conditions.

Genetic Counseling

Genetic counseling is the process of providing individuals and families with information on the nature, mode(s) of inheritance, and implications of genetic disorders to help them make informed medical and personal decisions. The following section deals with genetic risk assessment and the use of family history and genetic testing to clarify genetic status for family members; it is not meant to address all personal, cultural, or ethical issues that may arise or to substitute for consultation with a genetics professional. —ED.

Mode of Inheritance

Spinocerebellar ataxia type 3 (SCA3) is inherited in an autosomal dominant manner.

Risk to Family Members

Parents of a proband

  • Most individuals diagnosed with SCA3 have an affected parent.
  • A proband with SCA3 may have the disorder as the result of expansion of an intermediate ATXN3 CAG repeat inherited from a parent who does not manifest classic clinical features of SCA3.
  • If neither of the parents of the proband is known have SCA3, recommendations for the evaluation of parents include physical examination and consideration of ATXN3 molecular genetic testing.
  • The family history of some individuals diagnosed with SCA3 may appear to be negative because of failure to recognize the disorder in family members, early death of the parent before the onset of manifestations, or late onset of the disease in the affected parent. Therefore, an apparently negative family history cannot be confirmed unless appropriate molecular genetic testing has been performed on the parents of the proband.

Sibs of a proband. The risk to the sibs of a proband depends on the clinical/genetic status of the parents:

  • If a parent of the proband is affected and/or is known to have an intermediate or pathogenic ATXN3 CAG repeat expansion, the risk to each sib of inheriting the CAG repeat expansion is 50%. The CAG repeat may expand on transmission from parent to offspring resulting in an earlier age of onset and more severe disease manifestations in offspring (see Anticipation).
  • If an expanded CAG repeat cannot be detected in the leukocyte DNA of either parent, the risk to sibs is low but greater than that of the general population because of the theoretic possibility of parental germline mosaicism.
  • If the parents of a proband are clinically unaffected but their genetic status is unknown, sibs are still presumed to be at increased risk for SCA3 because of the possibility of late onset of SCA3 in a heterozygous parent or the theoretic possibility of parental germline mosaicism.

Offspring of a proband

  • Each child of an affected individual has a 50% chance of inheriting the ATXN3 CAG repeat expansion.
  • The CAG repeat may expand on transmission from proband to offspring resulting in an earlier age of onset and more severe disease manifestations in offspring (see Anticipation).

Other family members. The risk to other family members depends on the genetic status of the proband's parents: if a parent has the CAG repeat expansion, the parent's family members are at risk.

Related Genetic Counseling Issues

Note: If neither parent of a proband with SCA3 has an ATXN3 CAG repeat expansion, nonmedical explanations including alternate paternity or maternity (e.g., with assisted reproduction) and undisclosed adoption could also be explored.

Family planning

  • The optimal time for determination of genetic risk and discussion of the availability of prenatal/preimplantation genetic testing is before pregnancy.
  • It is appropriate to offer genetic counseling (including discussion of potential risks to offspring and reproductive options) to young adults who are affected or at risk.

At-risk individuals. The age of onset, severity, specific manifestations, and progression of SCA3 are variable and cannot be predicted by the family history or results of molecular genetic testing.

Predictive testing (i.e., testing of asymptomatic at-risk individuals)

  • Predictive testing for at-risk relatives is possible once molecular genetic testing has identified an ATXN3 CAG repeat expansion in an affected family member.
  • This testing is not useful in predicting age of onset, severity, type of symptoms, or rate of progression in asymptomatic individuals.
  • Potential consequences of such testing (including but not limited to socioeconomic changes and the need for long-term follow up and evaluation arrangements for individuals with a positive test result) as well as the capabilities and limitations of predictive testing should be discussed in the context of formal genetic counseling prior to testing.
  • Predictive genetic testing has proven beneficial in the Azore Islands, a region with high prevalence of SCA3 [Gonzalez et al 2004].

Predictive testing in minors (i.e., testing of asymptomatic at-risk individuals age <18 years)

  • For asymptomatic minors at risk for adult-onset conditions for which early treatment would have no beneficial effect on disease morbidity and mortality, predictive genetic testing is considered inappropriate, primarily because it negates the autonomy of the child with no compelling benefit. Further, concern exists regarding the potential unhealthy adverse effects that such information may have on family dynamics, the risk of discrimination and stigmatization in the future, and the anxiety that such information may cause.
  • For more information, see the National Society of Genetic Counselors position statement on genetic testing of minors for adult-onset conditions and the American Academy of Pediatrics and American College of Medical Genetics and Genomics policy statement: ethical and policy issues in genetic testing and screening of children.

In a family with an established diagnosis of SCA3, it is appropriate to consider testing of symptomatic individuals regardless of age.

Prenatal Testing and Preimplantation Genetic Testing

Once the ATXN3 CAG repeat expansion has been identified in an affected family member, prenatal and preimplantation genetic testing for SCA3 are possible. (Note: The prenatal finding of an ATXN3 CAG repeat expansion cannot be used to accurately predict onset, severity, type of symptoms, or rate of progression of SCA3.)

Differences in perspective may exist among medical professionals and within families regarding the use of prenatal testing. While most centers would consider use of prenatal testing to be a personal decision, discussion of these issues may be helpful.


GeneReviews staff has selected the following disease-specific and/or umbrella support organizations and/or registries for the benefit of individuals with this disorder and their families. GeneReviews is not responsible for the information provided by other organizations. For information on selection criteria, click here.

  • Ataxia MJD Research Project, Inc.
    1425 Alvarado Avenue
    Burlingame CA 94010-5547
    Email: info@ataxiamjd.org
  • NCBI Genes and Disease
  • Ataxia UK
    United Kingdom
    Phone: 0800 995 6037; +44 (0) 20 7582 1444 (from abroad)
    Email: help@ataxia.org.uk
  • euro-ATAXIA (European Federation of Hereditary Ataxias)
    United Kingdom
    Email: lporter@ataxia.org.uk
  • National Ataxia Foundation
    Phone: 763-553-0020
    Fax: 763-553-0167
    Email: naf@ataxia.org
  • Spanish Ataxia Federation (FEDAES)
    Phone: 601 037 982
    Email: info@fedaes.org
  • CoRDS Registry
    Sanford Research
    Phone: 605-312-6300

Molecular Genetics

Information in the Molecular Genetics and OMIM tables may differ from that elsewhere in the GeneReview: tables may contain more recent information. —ED.

Table A.

Spinocerebellar Ataxia Type 3: Genes and Databases

GeneChromosome LocusProteinLocus-Specific DatabasesHGMDClinVar
ATXN3 14q32​.12 Ataxin-3 ATXN3 database ATXN3 ATXN3

Data are compiled from the following standard references: gene from HGNC; chromosome locus from OMIM; protein from UniProt. For a description of databases (Locus Specific, HGMD, ClinVar) to which links are provided, click here.

Table B.

OMIM Entries for Spinocerebellar Ataxia Type 3 (View All in OMIM)

607047ATAXIN 3; ATXN3

Molecular Pathogenesis

ATXN3 encodes ataxin-3 (ATXN3), a de-ubiquitinating enzyme that is widely expressed in the brain and throughout the body, existing both in the cytoplasm and nucleus of various cell types. In neurons, ATXN3 is predominantly a cytoplasmic protein but the protein readily shuttles in and out of the nucleus, and tends to concentrate in neuronal nuclei in disease [Paulson et al 1997].

ATXN3 contains a variable CAG repeat that encodes a polyglutamine tract. Expansion of the CAG repeat is the molecular mechanism underlying the disease. When harboring the polyglutamine expansion encoded by the CAG repeat, ATXN3 is prone to aggregate and mislocalize in neurons [Paulson et al 2017, McLoughlin et al 2020].

SCA3 is one of several SCAs caused by polyglutamine-encoding CAG repeat expansions [Paulson et al 2017, Klockgether et al 2019].

Mechanism of disease causation. Gain of function

Table 6.

ATXN3 Technical Considerations

Technical IssueComment [Reference]
Sequence of repeatCAG
Methods to detect
expanded allele
(See Table 7.)
Conventional PCR is standard. Triplet-primed PCR (TP-PCR) [Melo et al 2016, Cagnoli et al 2018] & Southern blotting [Kawaguchi et al 1994] have also been described.
Somatic instability
  • Alleles w/abnormal number of CAG repeats may display somatic instability of the repeat, appearing as "smeared" expanded alleles w/multiple distinct expansion sizes on PCR & Southern blot analyses [Hashida et al 1997].
  • In early studies of the central nervous system, cerebellar tissues tended to have slightly smaller repeat lengths than other brain regions, but higher resolution analysis of somatic expansions employing single cell methods has not been published.
Germline instability
  • Typically, spermatozoa contain a larger repeat length than leukocytes in the same individuals [Watanabe et al 1996].
  • The probability of repeat expansion is greater w/paternal than w/maternal transmission, though the paternal bias is not pronounced.

Methods to characterize ATXN3 CAG repeats. Because of the technical challenges of detecting and sizing ATXN3 CAG repeat expansions, multiple methods may be needed to rule out or detect CAG repeat expansions (see Table 7). Repeats in the normal range (12-44) may be detected by traditional PCR. However, detection of apparent homozygosity for a normal CAG repeat does not rule out the presence of an expanded CAG repeat, thus, testing by triplet-primed PCR (TP-PCR) or Southern blotting is required. In addition, somatic and germline instability of expanded repeats must be considered.

Table 7.

Methods to Characterize ATXN3 CAG Repeats

Interpretation of CAG Repeat NumberExpected Results by Method
Conventional PCRTriplet-primed PCR 1Expanded repeat analysis 2
Normal: 12-44Detected 3See footnote 1.Expansions can be detected, and repeat size can be approximated. 4, 5
Intermediate 6Expansions may be detected, but repeat size cannot be determined. 7, 8
Pathogenic (full penetrance): ~60-97Expansions are detected, but repeat size cannot be determined. 8

The design of a triplet-primed PCR (TP-PCR) assay may include conventional PCR primers to size normal repeats and detect expanded repeats in a single assay. The TP-PCR assay itself does not determine repeat size, even alleles in the normal range.


Methods to detect and approximate the size of expanded repeats include long-range PCR sized by gel electrophoresis and Southern blotting. The upper limit of repeat size detected will vary by assay design, laboratory, sample, and/or affected individual as a result of competition by the normal allele during amplification.


Detection of an apparently homozygous repeat does not rule out the presence of an expanded CAG repeat; thus, testing by TP-PCR or expanded repeat analysis is required to detect a repeat expansion.


Southern blotting for the CAG repeat expansion has been described [Kawaguchi et al 1994].


Precise sizing of repeats is not necessary as clinical utility for determining the exact repeat number has not been demonstrated.


The smallest unstable repeat reported was 45 CAG repeats [Padiath et al 2005]. Some of these alleles are not associated with classic clinical features of SCA3 [Costa Mdo & Paulson 2012 and references therein].


TP-PCR for the CAG repeat expansion has been described [Melo et al 2016, Cagnoli et al 2018].


Repeats at the lower end of this range may not show the characteristic stutter pattern that indicates an expanded allele.

Table 8.

Notable ATXN3 Pathogenic Variants

Reference SequencesDNA Nucleotide ChangePredicted Protein ChangeRepeat Range
c.886_888CAG[60_86]p.Gln296[60_86]Full penetrance

Variants listed in the table have been provided by the authors. GeneReviews staff have not independently verified the classification of variants.

GeneReviews follows the standard naming conventions of the Human Genome Variation Society (varnomen​.hgvs.org). See Quick Reference for an explanation of nomenclature.

Chapter Notes

Author History

D Olga McDaniel, PhD; University of Mississippi Medical Center (1998-2006)
Henry Paulson, MD, PhD (2006-present)
Vikram Shakkottai, MD, PhD (2020-present)
Stephanie C Smith, MS; University of Mississippi Medical Center (1998-2006)
SH Subramony, MD; University of Mississippi Medical Center (1998-2006)
Parminder JS Vig, PhD; University of Mississippi Medical Center (1998-2006)

Revision History

  • 4 June 2020 (bp) Comprehensive update posted live
  • 24 September 2015 (me) Comprehensive update posted live
  • 17 March 2011 (me) Comprehensive update posted live
  • 3 August 2007 (me) Comprehensive update posted live
  • 30 September 2003 (me) Comprehensive update posted live
  • 24 May 2001 (me) Comprehensive update posted live
  • 10 October 1998 (pb) Review posted live
  • 13 July 1998 (shs) Original submission


Published Guidelines / Consensus Statements

  • Committee on Bioethics, Committee on Genetics, and American College of Medical Genetics and Genomics Social, Ethical, Legal Issues Committee. Ethical and policy issues in genetic testing and screening of children. Available online. 2013. Accessed 2-9-23.
  • National Society of Genetic Counselors. Position statement on genetic testing of minors for adult-onset conditions. Available online. 2018. Accessed 2-9-23.

Literature Cited

  • Ashizawa T, Öz G, Paulson HL. Spinocerebellar ataxias: prospects and challenges for therapy development. Nat Rev Neurol. 2018;14:590–605. [PMC free article: PMC6469934] [PubMed: 30131520]
  • Braga-Neto P, Pedroso JL, Alessi H, Dutra LA, Felício AC, Minett T, Weisman P, Santos-Galduroz RF, Bertolucci PH, Gabbai AA, Barsottini OG. Cerebellar cognitive affective syndrome in Machado Joseph disease: core clinical features. Cerebellum. 2012;11:549–56. [PubMed: 21975858]
  • Bürk K, Abele M, Fetter M, Dichgans J, Skalej M, Laccone F, Didierjean O, Brice A, Klockgether T. Autosomal dominant cerebellar ataxia type I clinical features and MRI in families with SCA1, SCA2 and SCA3. Brain. 1996;119:1497–505. [PubMed: 8931575]
  • Bürk K, Sival DA. Scales for the clinical evaluation of cerebellar disorders. Handb Clin Neurol. 2018;154:329–39. [PubMed: 29903450]
  • Bushart DD, Chopra R, Singh V, Murphy GG, Wulff H, Shakkottai VG. Targeting potassium channels to treat cerebellar ataxia. Ann Clin Transl Neurol. 2018;5:297–314. [PMC free article: PMC5846455] [PubMed: 29560375]
  • Cagnoli C, Brussino A, Mancini C, Ferrone M, Orsi L, Salmin P, Pappi P, Giorgio E, Pozzi E, Cavalieri S, Di Gregorio E, Ferrero M, Filla A, De Michele G, Gellera C, Mariotti C, Nethisinghe S, Giunti P, Stevanin G, Brusco A. Spinocerebellar ataxia tethering PCR: a rapid genetic test for the diagnosis of spinocerebellar ataxia types 1, 2, 3, 6, and 7 by PCR and capillary electrophoresis. J Mol Diagn. 2018;20:289–97. [PubMed: 29462666]
  • Cancel G, Abbas N, Stevanin G, Dürr A, Chneiweiss H, Neri C, Duyckaerts C, Penet C, Cann HM, Agid Y, Brice A. Marked phenotypic heterogeneity associated with expansion of a CAG repeat sequence at the spinocerebellar ataxia 3/Machado-Joseph disease locus. Am J Hum Genet. 1995;57:809–16. [PMC free article: PMC1801502] [PubMed: 7573040]
  • Carvalho DR, La Rocque-Ferreira A, Rizzo IM, Imamura EU, Speck-Martins CE. Homozygosity enhances severity in spinocerebellar ataxia type 3. Pediatr Neurol. 2008;38:296–9. [PubMed: 18358414]
  • Cecchin CR, Pires AP, Rieder CR, Monte TL, Silveira I, Carvalho T, Saraiva-Pereira ML, Sequeiros J, Jardim LB. Depressive symptoms in Machado-Joseph disease (SCA3) patients and their relatives. Community Genet. 2007;10:19–26. [PubMed: 17167246]
  • Costa Mdo C, Paulson HL. Toward understanding Machado Joseph disease. Prog Neurobiol. 2012;97:239–57. [PMC free article: PMC3306771] [PubMed: 22133674]
  • D'Abreu A, França M Jr, Conz L, Friedman JH, Nucci AM, Cendes F, Lopes-Cendes I. Sleep symptoms and their clinical correlates in Machado-Joseph disease. Acta Neurol Scand. 2009;119:277–80. [PubMed: 18771522]
  • D'Abreu A, França MC Jr, Paulson HL, Lopes-Cendes I. Caring for Machado-Joseph disease: current understanding and how to help patients. Parkinsonism Relat Disord. 2010;16:2–7. [PMC free article: PMC2818316] [PubMed: 19811945]
  • Duarte-Silva S, Maciel P. Pharmacological therapies for Machado-Joseph disease. Adv Exp Med Biol. 2018;1049:369–94. [PubMed: 29427114]
  • Dürr A, Stevanin G, Cancel G, Duyckaerts C, Abbas N, Didierjean O, Chneiweiss H, Benomar A, Lyon-Caen O, Julien J, Serdaru M, Penet C, Agid Y, Brice A. Spinocerebellar ataxia 3 and Machado-Joseph disease: clinical, molecular, and neuropathological features. Ann Neurol. 1996;39:490–9. [PubMed: 8619527]
  • Fowler HL. Machado-Joseph-Azorean disease. A ten-year study. Arch Neurol. 1984;41:921–5. [PubMed: 6477227]
  • França MC Jr, D'Abreu A, Friedman JH, Nucci A, Lopes-Cendes I. Chronic pain in Machado-Joseph disease: a frequent and disabling symptom. Arch Neurol. 2007;64:1767–70. [PubMed: 18071041]
  • França MC Jr, D'Abreu A, Nucci A, Cendes F, Lopes-Cendes I. Prospective study of peripheral neuropathy in Machado-Joseph disease. Muscle Nerve. 2009;40:1012–8. [PubMed: 19802879]
  • França MC Jr, D'Abreu A, Nucci A, Lopes-Cendes I. Clinical correlates of autonomic dysfunction in patients with Machado-Joseph disease. Acta Neurol Scand. 2010;121:422–5. [PubMed: 20070275]
  • Freeman W, Wszolek Z. Botulinum toxin type A for treatment of spasticity in spinocerebellar ataxia type 3 (Machado-Joseph disease). Mov Disord. 2005;20:644. [PubMed: 15747361]
  • Friedman JH. Presumed rapid eye movement behavior disorder in Machado-Joseph disease (spinocerebellar ataxia type 3). Mov Disord. 2002;17:1350–3. [PubMed: 12465081]
  • Friedman JH, Fernandez HH, Sudarsky LR. REM behavior disorder and excessive daytime somnolence in Machado-Joseph disease (SCA-3). Mov Disord. 2003;18:1520–2. [PubMed: 14673890]
  • Gan SR, Zhao K, Wu ZY, Wang N, Murong SX. Chinese patients with Machado-Joseph disease presenting with complicated hereditary spastic paraplegia. Eur J Neurol. 2009;16:953–6. [PubMed: 19453404]
  • Gaspar C, Lopes-Cendes I, DeStefano AL, Maciel P, Silveira I, Coutinho P, MacLeod P, Sequeiros J, Farrer LA, Rouleau GA. Linkage disequilibrium analysis in Machado-Joseph disease patients of different ethnic origins. Hum Genet. 1996;98:620–4. [PubMed: 8882886]
  • Gaspar C, Lopes-Cendes I, Hayes S, Goto J, Arvidsson K, Dias A, Silveira I, Maciel P, Coutinho P, Lima M, Zhou YX, Soong BW, Watanabe M, Giunti P, Stevanin G, Riess O, Sasaki H, Hsieh M, Nicholson GA, Brunt E, Higgins JJ, Lauritzen M, Tranebjaerg L, Volpini V, Wood N, Ranum L, Tsuji S, Brice A, Sequeiros J, Rouleau GA. Ancestral origins of the Machado-Joseph disease mutation: a worldwide haplotype study. Am J Hum Genet. 2001;68:523–8. [PMC free article: PMC1235286] [PubMed: 11133357]
  • Globas C, du Montcel ST, Baliko L, Boesch S, Depondt C, DiDonato S, Dürr A, Filla A, Klockgether T, Mariotti C, Melegh B, Rakowicz M, Ribai P, Rola R, Schmitz-Hubsch T, Szymanski S, Timmann D, Van de Warrenburg BP, Bauer P, Schöls L. Early symptoms in spinocerebellar ataxia type 1, 2, 3, and 6. Mov Disord. 2008;23:2232–8. [PubMed: 18759344]
  • Gonzalez C, Lima M, Kay T, Silva C, Santos C, Santos J. Short-term psychological impact of predictive testing for Machado-Joseph disease: depression and anxiety levels in individuals at risk from the Azores (Portugal). Community Genet. 2004;7:196–201. [PubMed: 15692194]
  • Hashida H, Goto J, Kurisaki H, Mizusawa H, Kanazawa I. Brain regional differences in the expansion of a CAG repeat in the spinocerebellar ataxias: dentatorubral-pallidoluysian atrophy, Machado- Joseph disease, and spinocerebellar ataxia type 1. Ann Neurol. 1997;41:505–11. [PubMed: 9124808]
  • Hoche F, Guell X, Vangel MG, Sherman JC, Schmahmann JD. The cerebellar cognitive affective/Schmahmann syndrome scale. Brain. 2018;141:248–70. [PMC free article: PMC5837248] [PubMed: 29206893]
  • Ilg W, Synofzik M, Brötz D, Burkard S, Giese MA, Schöls L. Intensive coordinative training improves motor performance in degenerative cerebellar disease. Neurology. 2009;73:1823–30. [PubMed: 19864636]
  • Isozaki E, Naito R, Kanda T, Mizutani T, Hirai S. Different mechanism of vocal cord paralysis between spinocerebellar ataxia (SCA 1 and SCA 3) and multiple system atrophy. J Neurol Sci. 2002;197:37–43. [PubMed: 11997064]
  • Joers JM, Deelchand DK, Lyu T, Emir UE, Hutter D, Gomez CM, Bushara KO, Eberly LE, Öz G. Neurochemical abnormalities in premanifest and early spinocerebellar ataxias. Ann Neurol. 2018;83:816–29. [PMC free article: PMC5912959] [PubMed: 29575033]
  • Kawaguchi Y, Okamoto T, Taniwaki M, Aizawa M, Inoue M, Katayama S, Kawakami H, Nakamura S, Nishimura M, Akiguchi I, Kimura J, Narumiya S, Kakizuka A. CAG expansions in a novel gene for Machado-Joseph disease at chromosome 14q32.1. Nat Genet. 1994;8:221–8. [PubMed: 7874163]
  • Kawai Y, Takeda A, Abe Y, Washimi Y, Tanaka F, Sobue G. Cognitive impairments in Machado-Joseph disease. Arch Neurol. 2004;61:1757–60. [PubMed: 15534186]
  • Kieling C, Prestes PR, Saraiva-Pereira ML, Jardim LB. Survival estimates for patients with Machado-Joseph disease (SCA3). Clin Genet. 2007;72:543–5. [PubMed: 17894834]
  • Klockgether T, Mariotti C, Paulson HL. Spinocerebellar ataxia. Nat Rev Dis Primers. 2019;5:24. [PubMed: 30975995]
  • Lerer I, Merims D, Abeliovich D, Zlotogora J, Gadoth N. Machado-Joseph disease: correlation between the clinical features, the CAG repeat length and homozygosity for the mutation. Eur J Hum Genet. 1996;4:3–7. [PubMed: 8800925]
  • Lima L, Coutinho P. Clinical criteria for diagnosis of Machado-Joseph disease: report of a non-Azorena Portuguese family. Neurology. 1980;30:319–22. [PubMed: 7189034]
  • Lin HC, Chang YY, Chang KH, Chen YF, Lan MY. Spastic paraparesis as the first manifestation of Machado-Joseph disease: A case report and review of the literature. Clin Neurol Neurosurg. 2018;172:137–40. [PubMed: 30007589]
  • Lin KP, Soong BW. Peripheral neuropathy of Machado-Joseph disease in Taiwan: a morphometric and genetic study. Eur Neurol. 2002;48:210–7. [PubMed: 12422070]
  • Lo RY, Figueroa KP, Pulst SM, Perlman S, Wilmot G, Gomez C, Schmahmann J, Paulson H, Shakkottai VG, Ying S, Zesiewicz T, Bushara K, Geschwind M, Xia G, Yu JT, Lee LE, Ashizawa T, Subramony SH, Kuo SH. Depression and clinical progression in spinocerebellar ataxias. Parkinsonism Relat Disord. 2016;22:87–92. [PMC free article: PMC4695274] [PubMed: 26644294]
  • Lu CS, Chang HC, Kuo PC, Liu YL, Wu WS, Weng YH, Yen TC, Chou YH. The parkinsonian phenotype of spinocerebellar ataxia type 3 in a Taiwanese family. Parkinsonism Relat Disord. 2004;10:369–73. [PubMed: 15261879]
  • Maciel P, Gaspar C, DeStefano AL, Silveira I, Coutinho P, Radvany J, Dawson DM, Sudarsky L, Guimaraes J, Loureiro JEL, Nezarati MM, Corwin LI, Lopes-Cendes I, Rooke K, Rosenberg R, MacLeod P, Farrer LA, Sequeiros J, Rouleau GA. Correlation between CAG repeat length and clinical features in Machado-Joseph disease. Am J Hum Genet. 1995;57:54–61. [PMC free article: PMC1801255] [PubMed: 7611296]
  • Martineau L, Noreau A, Dupré N. Therapies for ataxias. Curr Treat Options Neurol. 2014;16:300. [PubMed: 24832479]
  • Martinez AR, Nunes MB, Faber I, D'Abreu A, Lopes-Cendes Í, França MC Jr. Fatigue and its associated factors in spinocerebellar ataxia type 3/Machado-Joseph disease. Cerebellum. 2017;16:118–21. [PubMed: 27021342]
  • Martins S, Calafell F, Gaspar C, Wong VC, Silveira I, Nicholson GA, Brunt ER, Tranebjaerg L, Stevanin G, Hsieh M, Soong BW, Loureiro L, Dürr A, Tsuji S, Watanabe M, Jardim LB, Giunti P, Riess O, Ranum LP, Brice A, Rouleau GA, Coutinho P, Amorim A, Sequeiros J. Asian origin for the worldwide-spread mutational event in Machado-Joseph disease. Arch Neurol. 2007;64:1502–8. [PubMed: 17923634]
  • Matilla T, McCall A, Subramony SH, Zoghbi HY. Molecular and clinical correlations in spinocerebellar ataxia type 3 and Machado-Joseph disease. Ann Neurol. 1995;38:68–72. [PubMed: 7611728]
  • Matsumura R, Takayanagi T, Fujimoto Y, Murata K, Mano Y, Horikawa H, Chuma T. The relationship between trinucleotide repeat length and phenotypic variation in Machado-Joseph disease. J Neurol Sci. 1996;139:52–7. [PubMed: 8836972]
  • McLoughlin HS, Moore LR, Chopra R, Komlo R, McKenzie M, Blumenstein KG, Zhao H, Kordasiewicz HB, Shakkottai VG, Paulson HL. Oligonucleotide therapy mitigates disease in spinocerebellar ataxia type 3 mice. Ann Neurol. 2018;84:64–77. [PMC free article: PMC6119475] [PubMed: 29908063]
  • McLoughlin HS, Moore LR, Paulson HL. Pathogenesis of SCA3 and implications for other polyglutamine diseases. Neurobiol Dis. 2020;134:104635. [PMC free article: PMC6980715] [PubMed: 31669734]
  • Melo AR, Ramos A, Kazachkova N, Raposo M, Bettencourt BF, Rendeiro AR, Kay T, Vasconcelos J, Bruges-Armas J, Lima M. Triplet repeat primed PCR (TP-PCR) in molecular diagnostic testing for spinocerebellar ataxia type 3 (SCA3). Mol Diagn Ther. 2016;20:617–22. [PubMed: 27647319]
  • Mendonça N, França MC Jr, Gonçalves AF, Januário C. Clinical features of Machado-Joseph disease. Adv Exp Med Biol. 2018;1049:255–73. [PubMed: 29427108]
  • Miyai I, Ito M, Hattori N, Mihara M, Hatakenaka M, Yagura H, Sobue G, Nishizawa M. Cerebellar Ataxia Rehabilitation Trialists Collaboration. Cerebellar ataxia rehabilitation trial in degenerative cerebellar diseases. Neurorehabil Neural Repair. 2012;26:515–22. [PubMed: 22140200]
  • Nandagopal R, Moorthy SG. Dramatic levodopa responsiveness of dystonia in a sporadic case of spinocerebellar ataxia type 3. Postgrad Med J. 2004;80:363–5. [PMC free article: PMC1743016] [PubMed: 15192175]
  • Nunes MB, Martinez AR, Rezende TJ, Friedman JH, Lopes-Cendes I, D'Abreu A, França MC Jr. Dystonia in Machado-Joseph disease: clinical profile, therapy andanatomical basis. Parkinsonism Relat Disord. 2015;21:1441–7. [PubMed: 26552869]
  • Onodera O, Idezuka J, Igarashi S, Takiyama Y, Endo K, Takano H, Oyake M, Tanaka H, Inuzuka T, Hayashi T, Yuasa T, Ito J, Miyatake T, Tsuji S. Progressive atrophy of cerebellum and brainstem as a function of age and the size of the expanded CAG repeats in the MJD1 gene in Machado-Joseph disease. Ann Neurol. 1998;43:288–96. [PubMed: 9506544]
  • Padiath QS, Srivastava AK, Roy S, Jain S, Brahmachari SK. Identification of a novel 45 repeat unstable allele associated with a disease phenotype at the MJD1/SCA3 locus. Am J Med Genet B Neuropsychiatr Genet. 2005;133B:124–6. [PubMed: 15457499]
  • Paulson HL, Perez MK, Trottier Y, Trojanowski JQ, Subramony SH, Das SS, Vig P, Mandel JL, Fischbeck KH, Pittman RN. Intranuclear inclusions of expanded polyglutamine protein in spinocerebellar ataxia type 3. Neuron. 1997;19:333–44. [PubMed: 9292723]
  • Paulson HL, Shakkottai VG, Clark HB, Orr HT. Polyglutamine spinocerebellar ataxias - from genes to potential treatments. Nat Rev Neurosci. 2017;18:613–26. [PMC free article: PMC6420820] [PubMed: 28855740]
  • Pedroso JL, Braga-Neto P, Felício AC, Dutra LA, Santos WA, do Prado GF, Barsottini OG. Sleep disorders in Machado-Joseph disease: frequency, discriminative thresholds, predictive values, and correlation with ataxia-related motor and non-motor features. Cerebellum. 2011;10:291–5. [PubMed: 21287304]
  • Pedroso JL, Braga-Neto P, Martinez AR, Martins CR Jr, Rezende Filho FM, Sobreira-Neto MA, Prado LB, do Prado GF, França MC Jr, Barsottini OG. Sleep disorders in Machado-Joseph disease. Curr Opin Psychiatry. 2016;29:402–8. [PubMed: 27584711]
  • Rana AQ, Qureshi DT, Morshed M, Kachhvi ZM, Rana MA, Qureshi ARM. Ophthalmological features of Machado-Joseph disease. J Coll Physicians Surg Pak. 2016;26:137–9. [PubMed: 28666509]
  • Riess O, Rüb U, Pastore A, Bauer P, Schöls L. SCA3: neurological features, pathogenesis and animal models. Cerebellum. 2008;7:125–37. [PubMed: 18418689]
  • Roeske S, Filla I, Heim S, Amunts K, Helmstaedter C, Wüllner U, Wagner M, Klockgether T, Minnerop M. Progressive cognitive dysfunction in spinocerebellar ataxia type 3. Mov Disord. 2013;28:1435–8. [PubMed: 23736996]
  • Romano S, Coarelli G, Marcotulli C, Leonardi L, Piccolo F, Spadaro M, Frontali M, Ferraldeschi M, Vulpiani MC, Ponzelli F, Salvetti M, Orzi F, Petrucci A, Vanacore N, Casali C, Ristori G. Riluzole in patients with hereditary cerebellar ataxia: a randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2015;14:985–91. [PubMed: 26321318]
  • Rüb U, Brunt ER, Deller T. New insights into the pathoanatomy of spinocerebellar ataxia type 3 (Machado-Joseph disease). Curr Opin Neurol. 2008;21:111–6. [PubMed: 18317266]
  • Ruffieux N, Colombo F, Gentaz E, Annoni J-M, Chouiter L, Roulin Hefti S, Ruffieux A, Bihl T. Successful neuropsychological rehabilitation in a patient with cerebellar cognitive affective syndrome. Appl Neuropsychol Child. 2017;6:180–8. [PubMed: 27049666]
  • Sasaki H, Wakisaka A, Fukazawa T, Iwabuchi K, Hamada T, Takada A, Mukai E, Matsuura T, Yoshiki T, Tashiro K. CAG repeat expansion of Machado-Joseph disease in the Japanese: analysis of the repeat instability for parental transmission, and correlation with disease phenotype. J Neurol Sci. 1995;133:128–33. [PubMed: 8583215]
  • Schöls L, Amoiridis G, Epplen JT, Langkafel M, Przuntek H, Riess O. Relations between genotype and phenotype in German patients with the Machado-Joseph disease mutation. J Neurol Neurosurg Psychiatry. 1996;61:466–70. [PMC free article: PMC1074043] [PubMed: 8937340]
  • Schöls L, Haan J, Riess O, Amoiridis G, Przuntek H. Sleep disturbance in spinocerebellar ataxias: is the SCA3 mutation a cause of restless legs syndrome? Neurology. 1998;51:1603–7. [PubMed: 9855509]
  • Schöls L, Peters S, Szymanski S, Kruger R, Lange S, Hardt C, Riess O, Przuntek H. Extrapyramidal motor signs in degenerative ataxias. Arch Neurol. 2000;57:1495–500. [PubMed: 11030803]
  • Schulz JB, Borkert J, Wolf S, Schmitz-Hübsch T, Rakowicz M, Mariotti C, Schöls L, Timmann D, van de Warrenburg B, Dürr A, Pandolfo M, Kang JS, Mandly AG, Nägele T, Grisoli M, Boguslawska R, Bauer P, Klockgether T, Hauser TK. Visualization, quantification and correlation of brain atrophy with clinical symptoms in spinocerebellar ataxia types 1, 3 and 6. Neuroimage. 2010;49:158–68. [PubMed: 19631275]
  • Sequeiros J, Coutinho P. Epidemiology and clinical aspects of Machado-Joseph disease. Adv Neurol. 1993;61:139–53. [PubMed: 8421964]
  • Silva RC, Saute JA, Silva AC, Coutinho AC, Saraiva-Pereira ML, Jardim LB. Occupational therapy in spinocerebellar ataxia type 3: an open-label trial. Braz J Med Biol Res. 2010;43:537–42. [PubMed: 20414586]
  • Souza GN, Kersting N, Krum-Santos AC, Santos AS, Furtado GV, Pacheco D, Gonçalves TA, Saute JA, Schuler-Faccini L, Mattos EP, Saraiva-Pereira ML, Jardim LB. Spinocerebellar ataxia type 3/Machado-Joseph disease: segregation patterns and factors influencing instability of expanded CAG transmissions. Clin Genet. 2016;90:134–40. [PubMed: 26693702]
  • Subramony SH, Bock HG, Smith SC, Currier RD, et al. Presumed Machado-Joseph disease: four kindreds from Mississippi. In: Lechentenberg R, ed. Handbook of Cerebellar Diseases. New York, NY: Marcel Dekker; 1993:353-62.
  • Subramony SH, Hernandez D, Adam A, Smith-Jefferson S, Hussey J, Gwinn-Hardy K, Lynch T, McDaniel O, Hardy J, Farrer M, Singleton A. Ethnic differences in the expression of neurodegenerative disease: Machado-Joseph disease in Africans and Caucasians. Mov Disord. 2002;17:1068–71. [PubMed: 12360561]
  • Sudarsky L, Corwin L, Dawson DM. Machado-Joseph disease in New England: clinical description and distinction from the olivopontocerebellar atrophies. Mov Disord. 1992;7:204–8. [PubMed: 1620136]
  • Takazaki KA, D'Abreu A, Nucci A, Lopes-Cendes I, França MC Jr. Dysautonomia is frequent in Machado-Joseph disease: clinical and neurophysiological evaluation. Cerebellum. 2013;12:513–9. [PubMed: 23413156]
  • Tamura I, Takei A, Hamada S, Soma H, Nonaka M, Homma S, Moriwaka F. Executive dysfunction in patients with spinocerebellar ataxia type 3. J Neurol. 2018;265:1563–72. [PubMed: 29725839]
  • Teo AY, Goy RW, Woon YS. Combined spinal-epidural technique for vaginal hysterectomy in a patient with Machado-Joseph disease. Reg Anesth Pain Med. 2004;29:352–4. [PubMed: 15305255]
  • Vale J, Bugalho P, Silveira I, Sequeiros J, Guimarães J, Coutinho P. Autosomal dominant cerebellar ataxia: frequency analysis and clinical characterization of 45 families from Portugal. Eur J Neurol. 2010;17:124–8. [PubMed: 19659750]
  • van Alfen N, Sinke RJ, Zwarts MJ, Gabreels-Festen A, Praamstra P, Kremer BP, Horstink MW. Intermediate CAG repeat lengths (53,54) for MJD/SCA3 are associated with an abnormal phenotype. Ann Neurol. 2001;49:805–7. [PubMed: 11409435]
  • van de Warrenburg BP, Hendriks H, Dürr A, van Zuijlen MC, Stevanin G, Camuzat A, Sinke RJ, Brice A, Kremer BP. Age at onset variance analysis in spinocerebellar ataxias: a study in a Dutch-French cohort. Ann Neurol. 2005;57:505–12. [PubMed: 15747371]
  • van de Warrenburg BP, van Gaalen J, Boesch S, Burgunder JM, Dürr A, Giunti P, Klockgether T, Mariotti C, Pandolfo M, Riess O. EFNS/ENS Consensus on the diagnosis and management of chronic ataxias in adulthood. Eur J Neurol. 2014;21:552–62. [PubMed: 24418350]
  • Verbeek DS, Piersma SJ, Hennekam EF, Ippel EF, Pearson PL, Sinke RJ. Haplotype study in Dutch SCA3 and SCA6 families: evidence for common founder mutations. Eur J Hum Genet. 2004;12:441–6. [PubMed: 15026782]
  • Wang YG, Du J, Wang JL, Chen J, Chen C, Luo YY, Xiao ZQ, Jiang H, Yan XX, Xia K, Pan Q, Tang BS, Shen L. Six cases of SCA3/MJD patients that mimic hereditary spastic paraplegia in clinic. J Neurol Sci. 2009;285:121–4. [PubMed: 19608203]
  • Watanabe M, Abe K, Aoki M, Kameya T, Kaneko J, Shoji M, Ikeda M, Shizuka M, Ikeda Y, Iizuka T, Hirai S, Itoyama Y. Analysis of CAG trinucleotide expansion associated with Machado-Joseph disease. J Neurol Sci. 1996;136:101–7. [PubMed: 8815156]
  • Wolf AE, Mourão L, França MC Jr, Machado Júnior AJ, Crespo AN. Phonoarticulation in spinocerebellar ataxia type 3. Eur Arch Otorhinolaryngol. 2017;274:1139–45. [PubMed: 27491321]
  • Wu C, Chen DB, Feng L, Zhou XX, Zhang JW, You HJ, Liang XL, Pei Z, Li XH. Oculomotor deficits in spinocerebellar ataxia type 3: potential biomarkers of preclinical detection and disease progression. CNS Neurosci Ther. 2017;23:321–8. [PMC free article: PMC6492748] [PubMed: 28195427]
  • Yeh TH, Lu CS, Chou YH, Chong CC, Wu T, Han NH, Chen RS. Autonomic dysfunction in Machado-Joseph disease. Arch Neurol. 2005;62:630–6. [PubMed: 15824264]
  • Yoshizawa T, Nakamagoe K, Ueno T, Furusho K, Shoji S. Early vestibular dysfunction in Machado-Joseph disease detected by caloric test. J Neurol Sci. 2004;221:109–11. [PubMed: 15178224]
  • Zawacki TM, Grace J, Friedman JH, Sudarsky L. Executive and emotional dysfunction in Machado-Joseph disease. Mov Disord. 2002;17:1004–10. [PubMed: 12360550]
  • Zesiewicz TA, Wilmot G, Kuo SH, Perlman S, Greenstein PE, Ying SH, Ashizawa T, Subramony SH, Schmahmann JD, Figueroa KP, Mizusawa H, Schöls L, Shaw JD, Dubinsky RM, Armstrong MJ, Gronseth GS, Sullivan KL. Comprehensive systematic review summary: Treatment of cerebellar motor dysfunction and ataxia: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018;90:464–71. [PMC free article: PMC5863491] [PubMed: 29440566]
  • Zhou YX, Takiyama Y, Igarashi S, Li YF, Zhou BY, Gui DC, Endo K, Tanaka H, Chen ZH, Zhou LS, Fan MZ, Yang BX, Weissenbach J, Wang GX, Tsuji S. Machado-Joseph disease in four Chinese pedigrees: molecular analysis of 15 patients including two juvenile cases and clinical correlations. Neurology. 1997;48:482–5. [PubMed: 9040742]
Copyright © 1993-2024, University of Washington, Seattle. GeneReviews is a registered trademark of the University of Washington, Seattle. All rights reserved.

GeneReviews® chapters are owned by the University of Washington. Permission is hereby granted to reproduce, distribute, and translate copies of content materials for noncommercial research purposes only, provided that (i) credit for source (http://www.genereviews.org/) and copyright (© 1993-2024 University of Washington) are included with each copy; (ii) a link to the original material is provided whenever the material is published elsewhere on the Web; and (iii) reproducers, distributors, and/or translators comply with the GeneReviews® Copyright Notice and Usage Disclaimer. No further modifications are allowed. For clarity, excerpts of GeneReviews chapters for use in lab reports and clinic notes are a permitted use.

For more information, see the GeneReviews® Copyright Notice and Usage Disclaimer.

For questions regarding permissions or whether a specified use is allowed, contact: ude.wu@tssamda.

Bookshelf ID: NBK1196PMID: 20301375


Tests in GTR by Gene

Related information

  • MedGen
    Related information in MedGen
  • OMIM
    Related OMIM records
  • PMC
    PubMed Central citations
  • PubMed
    Links to PubMed
  • Gene
    Locus Links

Similar articles in PubMed

See reviews...See all...

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...