ArticleEuropean journal of neurology2026
Novel Clinical Insights From a Swedish RFC1 Spectrum Disorder Cohort.
Article in European journal of neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Uncovering Neuropathic Pain in CANVAS: Lessons from a Case-Based Literature Review.Pain and therapy · 2026Review
- Cramps as the initial presentation of CANVAS/RFC1-related disorder.Journal of neuromuscular diseases · 2026Article
- Novel Clinical Insights From a Swedish RFC1 Spectrum Disorder Cohort.European journal of neurology · 2026Article
- Predicting disease progression in progressive cerebellar ataxias: integrating clinical, imaging, fluid, genetic, and digital biomarkers.Frontiers in neurology · 2026Review
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Authors and funding
13 authors.
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Abstract
backgroundBiallelic pentanucleotide expansions in RFC1 cause cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS), and a growing spectrum of presentations. We aimed to clinically characterize a cohort of patients from Sweden with biallelic expansions in RFC1.
methodsWe retrospectively enrolled patients with homozygous expansions in RFC1 from a tertiary center in Sweden, evaluating clinical and genetic data. Assessments included nerve conduction studies (NCS, n = 27), electromyography (n = 7), quantitative sensory testing (n = 18), brain MRI (n = 27), and vestibular/eye motor tests (n = 18-21).
resultsOf the 30 patients enrolled, 28 were ethnic Swedish; 17/30 from smaller regions, including eight (27%) from Norrbotten. Twenty-two patients met the CANVAS criteria. Mean age of onset was 52 ± 12 years (range 20-70), and disease duration was 14 ± 12 years. Symptoms matched the CANVAS acronym with multisystemic features in 83%, including dysautonomia (77%), dyskinesia (36%), and bradykinesia (17%). Phenotypes overlapped with MSA-C (n = 2) and mitochondrial ataxias (n = 1). Notably, one symptomatic patient lacked neuropathy on NCS. Annual disease progression was slow (0.3 by spinocerebellar degeneration functional score, 1.2 by SARA). At vestibular testing, 47% showed a preserved caloric response and pathologic angular VOR with a nonsignificant trend among younger patients and milder ataxia; otolith function was largely preserved. DISCUSSION: Our findings expand the RFC1 spectrum, suggesting a founder effect in Sweden and extensive subclinical involvement. RFC1-spectrum disorder should also be considered in patients with cerebellar and vestibular dysfunction but lacking neuropathy. A discordant VOR pattern may represent an incipient sign of RFC1-spectrum disorder; interestingly, otolith pathways seem to be generally spared.
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