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Ghada El Euch-Fayache, MD; Irfan Lalani, MD; Rim Amouri, PhD; Ilhem Turki, MD; Karim Ouahchi, MD; Wu-Yen Hung, MD; Samir Belal, MD; Teepu Siddique, MD; Fayçal Hentati, MD

Arch Neurol. 2003;60:982-988.

Background  Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a clinically homogenous disorder reported in Quebec caused by mutations in the SACS gene (chromosome 13q12). Recently, we identified a Tunisian kindred demonstrating linkage to the ARSACS locus.

Objective  To report clinical, neurophysiological, and nerve biopsy findings in patients with autosomal recessive cerebellar ataxia related to the SACS gene in Tunisia.

Patients and Methods  Genetic linkage analysis of patients with early-onset autosomal recessive cerebellar ataxia allowed the identification of 4 families from which 18 patients demonstrated linkage to the ARSACS locus. The patients were evaluated according to the International Cooperative Ataxia Rating Scale. Peripheral nerve conduction, sensory evoked potentials, and nerve biopsy were performed in most patients.

Results  The mean age at onset was 4.5 years. The clinical phenotype was stereotyped and associated with a progressive cerebellar syndrome, a pyramidal syndrome with brisk knee reflexes, and Babinski sign and absent ankle reflexes. The course of the disease varied among patients. Sensory evoked potentials showed severe posterior column involvement. Peripheral nerve investigations demonstrated axonal and demyelinating neuropathy. Four mutations, 2 missense and 2 nonsense, were found.

Conclusion  In Tunisia, autosomal recessive cerebellar ataxia related to the SACS gene demonstrated a homogenous phenotype and heterogeneous allelic mutations.

From the Department of Neurology, National Institute of Neurology, Tunis, Tunisia (Drs El Euch-Fayache, Amouri, Turki, Belal, and Hentati); and the Department of Neurology, Northwestern University Medical School (Drs Lalani, Ouahchi, Hung, and Siddique), and Department of Pathology, McGaw Medical Center of Northwestern University (Dr Ouahchi), Chicago, Ill.

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