Application of the Scale for Assessment and Rating of Ataxia in toddlers

Sleep-related problems and sleep disorders in ataxia telangiectasia

OBJECTIVE

Ataxia telangiectasia (AT) is a rare neurodegenerative disorder and sleep-related problems may be expected. We investigated sleep-related problems in children with AT in relation to their clinical status.

METHODS

We administered Children's Sleep Habits Questionnaire and Sleep Disturbance Scale for Children to patients with AT (n = 46) and a matched healthy control (HC) (n = 92). We defined clinical subgroups of AT as mild (n = 10) and moderate/severe (n = 36) according to patients' clinical scores. We compared the results between the groups.

RESULTS

The median age was 130.5 (104.8-175.0) months in AT patients and 125.5 (85.0-177.0) months in HC. The frequency (6.5 % in AT, 0 % in HC), risk of sleep disturbance (60 % in AT, 25 % in HC), and sleep problems (80 % in AT, 50 % in HC) were higher in AT than in HC. As the male/female ratio differed between AT and HC in our study, we applied further analyses adjusting for gender and age; AT patients were almost 4.5 times more likely to develop sleep disturbances and 6 times more likely to have sleep problems than HC. Sleep-related problems decreased with increasing age in HC; sleep problems partially decreased in AT, but sleep disturbances did not decrease in AT.

CONCLUSION

Sleep architecture, behavior, and habits may be disturbed in AT, justifying the inclusion of sleep screening tools in the clinical follow-up of these patients even if no symptoms are reported in the medical history. Further clinical studies in large cohorts are needed to develop sleep screening tools specific to AT and similar neurodegenerative diseases.

Validation of the Italian Version of the Scale for the Assessment and Rating of Ataxia (SARA) in Multiple Sclerosis: A Cross-Sectional Study

Multiple sclerosis (MS) is a chronic neurodegenerative disorder often associated with cerebellar ataxia. Accurate assessment of ataxia is crucial for monitoring disease progression and guiding rehabilitation. The Scale for the Assessment and Rating of Ataxia (SARA) is a clinician-reported outcome measure (ClinRO) designed to evaluate ataxia severity. This study aimed to translate, culturally adapt, and validate the Italian version of SARA in individuals with MS. This study follows a cross-sectional design and was conducted at the Neurorehabilitation Unit of Sapienza University of Rome. The translation followed ISPOR and ISOQOL guidelines to ensure linguistic and cultural equivalence. Psychometric properties evaluation included internal consistency (Cronbach's alpha), test-retest reliability (intraclass correlation coefficient [ICC]), construct validity (correlation with Berg Balance Scale [BBS], Mini-Balance Evaluation Systems Test [Mini-BESTest], and Timed Up and Go [TUG] test), and cross-cultural validity. Seventy-five MS patients (EDSS ≤ 6.5) were recruited. The Italian SARA version demonstrated excellent internal consistency (Cronbach's alpha = 0.855) and test-retest reliability (ICC = 0.993). Strong negative correlations were found with BBS (r = -0.838, p < 0.001) and Mini-BESTest (r = -0.767, p < 0.001), supporting construct validity. Significant differences emerged based on age, employment status, and EDSS scores. The Italian SARA is a valid and reliable tool for assessing ataxia severity in MS. Its strong psychometric properties support its use in clinical and research settings. Future studies should explore its responsiveness to rehabilitation interventions.

Improving paediatric movement disorders care: Insights on rating scales utilization and clinical practice

AIM

This exploratory study evaluates rating scale usage by experts from the European Reference Network for Rare Neurological Diseases (ERN-RND) for paediatric MD, considering factors like diagnosis, intellectual disability, age, and transition to adult care. The aim is to propose a preliminary framework for consistent application.

METHODS

A multicentre survey among 25 ERN-RND experts from 10 European countries examined rating scale usage in paediatric MD, categorizing MD into acute, non-progressive, and neurodegenerative types. Factors influencing scale choice and the transition to adult care practices were analysed. A comprehensive literature search was conducted to identify the earliest age of application of these scales in paediatric patients.

RESULTS

The study identifies various rating scales and establishes their usage frequencies for different MDs. Experts highlighted the need for standardized scales and proposed preliminary evaluation strategies based on clinical contexts. Challenges in applying scales to young, non-cooperative patients were acknowledged.

INTERPRETATION

The study recommends developing standardized rating scales for paediatric MDs to improve evaluations and data collection. It suggests potential scales for specific clinical scenarios to better evaluate disease progression. Comprehensive, patient-centred care remains crucial during the transition to adult care, despite the identified challenges. This exploratory approach aims to enhance patient outcomes and care.

Proceedings of the first global meeting of the Posterior Fossa Society: state of the art in cerebellar mutism syndrome

PURPOSE

The Posterior Fossa Society, an international multidisciplinary group, hosted its first global meeting designed to share the current state of the evidence across the multidisciplinary elements of pediatric post-operative cerebellar mutism syndrome (pCMS). The agenda included keynote talks from world-leading speakers, compelling abstract presentations and engaging discussions led by members of the PFS special interest groups.

METHODS

This paper is a synopsis of the first global meeting, a 3-day program held in Liverpool, England, UK, in September 2022.

RESULTS

Topics included nosology, patient and family experience, cerebellar modulation of cognition, and cerebellar cognitive affective syndrome. In addition, updates from large-scale studies were shared as well as abstracts across neuroradiology, neurosurgery, diagnosis/scoring, ataxia, and rehabilitation.

CONCLUSIONS

Based on data-driven evidence and discussions, each special interest group created research priorities to target before the second global meeting, in the spring of 2024.

A child with polyarthritis and chronic lung disease: a case report of ataxia-telangiectasia

BACKGROUND

Ataxia-telangiectasia (A-T) is a rare autosomal recessive DNA repair disorder, characterized by progressive cerebellar degeneration, telangiectasia, immunodeficiency, recurrent sinopulmonary infections, radiation sensitivity, premature aging and predisposition to cancer. Although the association with autoimmune and chronic inflammatory conditions such as vitiligo, thrombocytopenia and arthritis has occasionally been reported, an onset with articular involvement at presentation is rare.

CASE PRESENTATION

We herein report the case of a 7-year-old Caucasian girl who was admitted to the Rheumatology Department with a history of febrile chough and polyarthritis which led initially to the suspicion of an autoinflammatory disease. She had overt polyarthritis with knees deformities and presented with severe pneumonia. A chest Computed Tomography (CT) scan showed bilateral bronchiectasis, parenchymal consolidation and interstitial lung disease; rheumatoid factor and type I interferon signature resulted negative, therefore excluding COatomer Protein subunit Alpha (COPA) syndrome. A diagnosis of sarcoidosis had been suspected based on histological evidence of granulomatous liver inflammation, but ruled out after detecting normal angiotensin converting enzyme and chitotriosidase blood levels. Based on her past medical history characterized by at least six episodes of pneumonia in the previous 4 years, immunological phenotyping was performed. This showed complete IgA and IgE deficiency with defective antigen-specific antibodies to Pneumococcal, Tetanus toxin and Hemophilus Influenzae B vaccines. Additionally, low numbers of B cells and recent thymic emigrants (RTE) were found (CD4Ra 1.4%), along with a low CD4+/CD8 + T cells ratio (< 1). Finally, based on gait disturbances (wobbly wide-based walking), serum alfa-fetoprotein was dosed, which resulted increased at 276 ng/ml (normal value < 7 ng/ml). A diagnosis of Ataxia-Telangiectasia was made, strengthened by the presence of bulbar telangiectasia, and then confirmed by Whole Exome Sequencing (WES).

CONCLUSIONS

Although rare, A-T should always be ruled out in case of pulmonary bronchiectasis and gait disturbances even in the absence of bulbar or skin telangiectasia. Autoimmune and granulomatous disorders must to be considered as differential diagnosis.

Auto-Gait: Automatic Ataxia Risk Assessment with Computer Vision on Gait Task Videos

Many patients with neurological disorders, such as Ataxia, do not have easy access to neurologists, -especially those living in remote localities and developing/underdeveloped countries. Ataxia is a degenerative disease of the nervous system that surfaces as difficulty with motor control, such as walking imbalance. Previous studies have attempted automatic diagnosis of Ataxia with the help of wearable biomarkers, Kinect, and other sensors. These sensors, while accurate, do not scale efficiently well to naturalistic deployment settings. In this study, we propose a method for identifying ataxic symptoms by analyzing videos of participants walking down a hallway, captured with a standard monocular camera. In a collaboration with 11 medical sites located in 8 different states across the United States, we collected a dataset of 155 videos along with their severity rating from 89 participants (24 controls and 65 diagnosed with or are pre-manifest spinocerebellar ataxias). The participants performed the gait task of the Scale for the Assessment and Rating of Ataxia (SARA). We develop a computer vision pipeline to detect, track, and separate the participants from their surroundings and construct several features from their body pose coordinates to capture gait characteristics such as step width, step length, swing, stability, speed, etc. Our system is able to identify and track a patient in complex scenarios. For example, if there are multiple people present in the video or an interruption from a passerby. Our Ataxia risk-prediction model achieves 83.06% accuracy and an 80.23% F1 score. Similarly, our Ataxia severity-assessment model achieves a mean absolute error (MAE) score of 0.6225 and a Pearson's correlation coefficient score of 0.7268. Our model competitively performed when evaluated on data from medical sites not used during training. Through feature importance analysis, we found that our models associate wider steps, decreased walking speed, and increased instability with greater Ataxia severity, which is consistent with previously established clinical knowledge. Furthermore, we are releasing the models and the body-pose coordinate dataset to the research community - the largest dataset on ataxic gait (to our knowledge). Our models could contribute to improving health access by enabling remote Ataxia assessment in non-clinical settings without requiring any sensors or special cameras. Our dataset will help the computer science community to analyze different characteristics of Ataxia and to develop better algorithms for diagnosing other movement disorders.