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Nystagmus 4, congenital, autosomal dominant(SCA27A)

MedGen UID:
348103
Concept ID:
C1860433
Disease or Syndrome
Synonyms: SCA27A; SPINOCEREBELLAR ATAXIA 27A; Vestibulocerebellar disorder with predominant ocular signs
 
Gene (location): FGF14 (13q33.1)
 
Monarch Initiative: MONDO:0008654
OMIM®: 193003

Definition

Spinocerebellar ataxia-27A (SCA27A) is an autosomal dominant neurologic disorder characterized by general cerebellar dysfunction manifest as gait disturbances, ataxia, tremor, dysarthria, and gaze-evoked nystagmus. The age at onset is highly variable: some patients present in infancy with nystagmus or delayed motor development, whereas others present as adults with tremor or gait difficulties. The disorder is slowly progressive, and ataxia may be very subtle or even absent. Cerebellar atrophy may or may not be observed on brain imaging. Individuals with SCA27A often show mild developmental delay with variably impaired intellectual development. Many patients report an exacerbation of symptoms with fever, emotional stress, or exercise, which can be reminiscent of episodic ataxia or be associated with outbursts, depression, or other behavioral and psychiatric disturbances. There is significant inter- and intrafamilial variability and patients show various combinations of neurologic features (summary by Tucker et al., 2013; Piarroux et al., 2020; Ceroni et al., 2023). For a general discussion of autosomal dominant spinocerebellar ataxia, see SCA1 (164400). [from OMIM]

Clinical features

From HPO
Pes cavus
MedGen UID:
675590
Concept ID:
C0728829
Congenital Abnormality
The presence of an unusually high plantar arch. Also called high instep, pes cavus refers to a distinctly hollow form of the sole of the foot when it is bearing weight.
Abnormal vestibulo-ocular reflex
MedGen UID:
867213
Concept ID:
C4021571
Anatomical Abnormality
An abnormality of the vestibulo-ocular reflex (VOR). The VOR attempts to keep the image stable on the retina. Ideally passive or active head movements in one direction are compensated for by eye movements of equal magnitude.
Depression
MedGen UID:
4229
Concept ID:
C0011581
Mental or Behavioral Dysfunction
Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior.
Dysarthria
MedGen UID:
8510
Concept ID:
C0013362
Mental or Behavioral Dysfunction
Dysarthric speech is a general description referring to a neurological speech disorder characterized by poor articulation. Depending on the involved neurological structures, dysarthria may be further classified as spastic, flaccid, ataxic, hyperkinetic and hypokinetic, or mixed.
Orofacial dyskinesia
MedGen UID:
57747
Concept ID:
C0152115
Disease or Syndrome
Syndromes which feature dyskinesias as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions.
Postural tremor
MedGen UID:
66696
Concept ID:
C0234378
Sign or Symptom
A type of tremors that is triggered by holding a limb in a fixed position.
Cerebellar atrophy
MedGen UID:
196624
Concept ID:
C0740279
Disease or Syndrome
Cerebellar atrophy is defined as a cerebellum with initially normal structures, in a posterior fossa with normal size, which displays enlarged fissures (interfolial spaces) in comparison to the foliae secondary to loss of tissue. Cerebellar atrophy implies irreversible loss of tissue and result from an ongoing progressive disease until a final stage is reached or a single injury, e.g. an intoxication or infectious event.
Limb ataxia
MedGen UID:
196692
Concept ID:
C0750937
Finding
A kind of ataxia that affects movements of the extremities.
Gait ataxia
MedGen UID:
155642
Concept ID:
C0751837
Sign or Symptom
A type of ataxia characterized by the impairment of the ability to coordinate the movements required for normal walking. Gait ataxia is characteirzed by a wide-based staggering gait with a tendency to fall.
Impaired vibratory sensation
MedGen UID:
220959
Concept ID:
C1295585
Finding
A decrease in the ability to perceive vibration. Clinically, this is usually tested with a tuning fork which vibrates at 128 Hz and is applied to bony prominences such as the malleoli at the ankles or the metacarpal-phalangeal joints. There is a slow decay of vibration from the tuning fork. The degree of vibratory sense loss can be crudely estimated by counting the number of seconds that the examiner can perceive the vibration longer than the patient.
Strabismus
MedGen UID:
21337
Concept ID:
C0038379
Disease or Syndrome
A misalignment of the eyes so that the visual axes deviate from bifoveal fixation. The classification of strabismus may be based on a number of features including the relative position of the eyes, whether the deviation is latent or manifest, intermittent or constant, concomitant or otherwise and according to the age of onset and the relevance of any associated refractive error.
Gaze-evoked nystagmus
MedGen UID:
75750
Concept ID:
C0271390
Disease or Syndrome
Nystagmus made apparent by looking to the right or to the left.
Upbeat nystagmus
MedGen UID:
107943
Concept ID:
C0585545
Finding
In primary position, the eyes drift slowly downward and then spontaneously beat upward. Upward gaze accentuates the nystagmus. The associated oscillopsias are often very irritating, but the symptoms are usually transient.
Impaired smooth pursuit
MedGen UID:
325176
Concept ID:
C1837458
Finding
An impairment of the ability to track objects with the ocular smooth pursuit system, a class of rather slow eye movements that minimizes retinal target motion.
Absent smooth pursuit
MedGen UID:
870481
Concept ID:
C4024928
Finding
A complete lack of the ability to track objects with the ocular smooth pursuit system, a class of rather slow eye movements that minimizes retinal target motion.

Professional guidelines

PubMed

Yi Z, Sun W, Xiao X, Li S, Jia X, Li X, Yu B, Wang P, Zhang Q
Exp Eye Res 2021 Jul;208:108637. Epub 2021 May 26 doi: 10.1016/j.exer.2021.108637. PMID: 34048777
Vasilyeva TA, Marakhonov AV, Voskresenskaya AA, Kadyshev VV, Käsmann-Kellner B, Sukhanova NV, Katargina LA, Kutsev SI, Zinchenko RA
J Med Genet 2021 Apr;58(4):270-274. Epub 2020 May 28 doi: 10.1136/jmedgenet-2019-106172. PMID: 32467297
Chan WH, Biswas S, Ashworth JL, Lloyd IC
Eur J Pediatr 2012 Apr;171(4):625-30. Epub 2012 Mar 1 doi: 10.1007/s00431-012-1700-1. PMID: 22383071

Recent clinical studies

Etiology

Zhao M, Chen YJ, Wang MW, Lin XH, Dong EL, Chen WJ, Wang N, Lin X
Mol Diagn Ther 2019 Dec;23(6):781-789. doi: 10.1007/s40291-019-00426-w. PMID: 31630374
Leguire LE, Kashou NH, Fogt N, Smith MA, Lewis JR, Kulwin R, Rogers GL
J Pediatr Ophthalmol Strabismus 2011 Nov-Dec;48(6):347-56. Epub 2011 Jan 25 doi: 10.3928/01913913-20110118-03. PMID: 21261242
Abadi RV, Bjerre A
Br J Ophthalmol 2002 Oct;86(10):1152-60. doi: 10.1136/bjo.86.10.1152. PMID: 12234898Free PMC Article
Kunst H, Marres H, Huygen P, Van Camp G, Joosten F, Cremers C
Audiology 1999 May-Jun;38(3):165-73. doi: 10.3109/00206099909073018. PMID: 10437687
Lee NB, Kelly L, Sharland M
Eye (Lond) 1992;6 ( Pt 3):328-34. doi: 10.1038/eye.1992.66. PMID: 1446772

Diagnosis

Matsushita I, Morita H, Kondo H
Jpn J Ophthalmol 2020 Nov;64(6):635-641. Epub 2020 Aug 28 doi: 10.1007/s10384-020-00766-9. PMID: 32857266
Zhao M, Chen YJ, Wang MW, Lin XH, Dong EL, Chen WJ, Wang N, Lin X
Mol Diagn Ther 2019 Dec;23(6):781-789. doi: 10.1007/s40291-019-00426-w. PMID: 31630374
Thomas S, Thomas MG, Andrews C, Chan WM, Proudlock FA, McLean RJ, Pradeep A, Engle EC, Gottlob I
Eur J Hum Genet 2014 Mar;22(3):344-9. Epub 2013 Aug 14 doi: 10.1038/ejhg.2013.162. PMID: 23942204Free PMC Article
Chan WH, Biswas S, Ashworth JL, Lloyd IC
Eur J Pediatr 2012 Apr;171(4):625-30. Epub 2012 Mar 1 doi: 10.1007/s00431-012-1700-1. PMID: 22383071
Desir J, Abramowicz M
Orphanet J Rare Dis 2008 Oct 15;3:28. doi: 10.1186/1750-1172-3-28. PMID: 18922146Free PMC Article

Therapy

Tsunemi T, Ishikawa K, Tsukui K, Sumi T, Kitamura K, Mizusawa H
J Neurol Sci 2010 May 15;292(1-2):81-4. Epub 2010 Feb 23 doi: 10.1016/j.jns.2010.01.021. PMID: 20181362

Prognosis

Alzahem T, Alsalamah AK, Mura M, Alsulaiman SM
Ophthalmic Genet 2020 Aug;41(4):377-380. Epub 2020 Jun 5 doi: 10.1080/13816810.2020.1776339. PMID: 32498638
Thomas S, Thomas MG, Andrews C, Chan WM, Proudlock FA, McLean RJ, Pradeep A, Engle EC, Gottlob I
Eur J Hum Genet 2014 Mar;22(3):344-9. Epub 2013 Aug 14 doi: 10.1038/ejhg.2013.162. PMID: 23942204Free PMC Article
Chan WH, Biswas S, Ashworth JL, Lloyd IC
Eur J Pediatr 2012 Apr;171(4):625-30. Epub 2012 Mar 1 doi: 10.1007/s00431-012-1700-1. PMID: 22383071
Desir J, Abramowicz M
Orphanet J Rare Dis 2008 Oct 15;3:28. doi: 10.1186/1750-1172-3-28. PMID: 18922146Free PMC Article
Kunst H, Marres H, Huygen P, Van Camp G, Joosten F, Cremers C
Audiology 1999 May-Jun;38(3):165-73. doi: 10.3109/00206099909073018. PMID: 10437687

Clinical prediction guides

Matsushita I, Morita H, Kondo H
Jpn J Ophthalmol 2020 Nov;64(6):635-641. Epub 2020 Aug 28 doi: 10.1007/s10384-020-00766-9. PMID: 32857266
Thomas S, Thomas MG, Andrews C, Chan WM, Proudlock FA, McLean RJ, Pradeep A, Engle EC, Gottlob I
Eur J Hum Genet 2014 Mar;22(3):344-9. Epub 2013 Aug 14 doi: 10.1038/ejhg.2013.162. PMID: 23942204Free PMC Article
Chan WH, Biswas S, Ashworth JL, Lloyd IC
Eur J Pediatr 2012 Apr;171(4):625-30. Epub 2012 Mar 1 doi: 10.1007/s00431-012-1700-1. PMID: 22383071
Dudding TE, Friend K, Schofield PW, Lee S, Wilkinson IA, Richards RI
Neurology 2004 Dec 28;63(12):2288-92. doi: 10.1212/01.wnl.0000147299.80872.d1. PMID: 15623688
Kerrison JB, Vagefi MR, Barmada MM, Maumenee IH
Am J Hum Genet 1999 Feb;64(2):600-7. doi: 10.1086/302244. PMID: 9973299Free PMC Article

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