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JAMA Neurol. 2014 Oct;71(10):1237-46. doi: 10.1001/jamaneurol.2014.1944.

Exome sequencing in the clinical diagnosis of sporadic or familial cerebellar ataxia.

Author information

1
Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles.
2
Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles3UCLA Clinical Genomics Center, David Geffen School of Medicine, University of California at Los Angeles.
3
UCLA Clinical Genomics Center, David Geffen School of Medicine, University of California at Los Angeles4Department of Human Genetics, David Geffen School of Medicine, University of California at Los Angeles5Department of Pediatrics, David Geffen School of.
4
Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles3UCLA Clinical Genomics Center, David Geffen School of Medicine, University of California at Los Angeles4Department of Human Genetics.
5
Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles4Department of Human Genetics, David Geffen School of Medicine, University of California at Los Angeles.
6
Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles2Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles3UCLA Clin.

Erratum in

  • JAMA Neurol. 2015 Jan;72(1):128.

Abstract

IMPORTANCE:

Cerebellar ataxias are a diverse collection of neurologic disorders with causes ranging from common acquired etiologies to rare genetic conditions. Numerous genetic disorders have been associated with chronic progressive ataxia and this consequently presents a diagnostic challenge for the clinician regarding how to approach and prioritize genetic testing in patients with such clinically heterogeneous phenotypes. Additionally, while the value of genetic testing in early-onset and/or familial cases seems clear, many patients with ataxia present sporadically with adult onset of symptoms and the contribution of genetic variation to the phenotype of these patients has not yet been established.

OBJECTIVE:

To investigate the contribution of genetic disease in a population of patients with predominantly adult- and sporadic-onset cerebellar ataxia.

DESIGN, SETTING, AND PARTICIPANTS:

We examined a consecutive series of 76 patients presenting to a tertiary referral center for evaluation of chronic progressive cerebellar ataxia.

MAIN OUTCOMES AND MEASURES:

Next-generation exome sequencing coupled with comprehensive bioinformatic analysis, phenotypic analysis, and clinical correlation.

RESULTS:

We identified clinically relevant genetic information in more than 60% of patients studied (n = 46), including diagnostic pathogenic gene variants in 21% (n = 16), a notable yield given the diverse genetics and clinical heterogeneity of the cerebellar ataxias.

CONCLUSIONS AND RELEVANCE:

This study demonstrated that clinical exome sequencing in patients with adult-onset and sporadic presentations of ataxia is a high-yield test, providing a definitive diagnosis in more than one-fifth of patients and suggesting a potential diagnosis in more than one-third to guide additional phenotyping and diagnostic evaluation. Therefore, clinical exome sequencing is an appropriate consideration in the routine genetic evaluation of all patients presenting with chronic progressive cerebellar ataxia.

PMID:
25133958
PMCID:
PMC4324730
DOI:
10.1001/jamaneurol.2014.1944
[Indexed for MEDLINE]
Free PMC Article

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