Friedreich's Ataxia: Symptoms, Causes, And Diagnosis - Healthline

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HealthlineSubscribeFriedreich’s Ataxia

Medically reviewed by Megan Soliman, MD — Written by Amanda Delgado — Updated on January 18, 2024

Symptoms
Causes
Diagnosis
Treatment
Outlook
Prevention
FAQ

Friedreich’s ataxia is a rare genetic disease that causes difficulty walking, a loss of sensation in the arms and legs, and impaired speech. It’s also known as spinocerebellar degeneration.

“Ataxia” means lack of order. There are a number of types of ataxia with a number of causes. The disease causes damage to parts of your brain and spinal cord, and can also affect your heart.

Friedreich’s ataxia affects approximately 1 in every 40,000 people. Although there’s no cure for Friedreich’s ataxia, there are several treatments available to help you cope with the symptoms.

Symptoms of Friedreich’s ataxia

Friedreich’s ataxia can be diagnosed between the age 2 and a person’s early 50s, but it’s most commonly diagnosed between ages 10 and 15.

Difficulty with walking is the most common initial symptom of the condition. Other symptoms include:

vision changes
loss of hearing
weak muscles
lack of reflexes in your legs
poor coordination or lack of coordination
speech problems
involuntary eye movements
foot deformities, such as clubfoot
difficulty sensing vibrations in your legs and feet

Many people with this condition also have some form of heart disease. Approximately 75 percent of people with Friedreich’s ataxia have heart abnormalities. The most common type is hypertrophic cardiomyopathy, a thickening of the heart muscle.

The symptoms of heart disease might include heart palpitations, chest pain, dizziness, light-headedness, or shortness of breath. Friedreich’s ataxia is also associated with a greater risk of developing diabetes.

Causes of Friedreich’s ataxia

Friedreich’s ataxia is a genetic disorder that’s inherited from both parents by what’s called “autosomal recessive transmission.” The disease is linked to a gene called FXN. Normally this gene will cause your body to produce up to 33 copies of a specific DNA sequence.

In people with Friedreich’s ataxia, this sequence may repeat 66 to over 1,000 times, according to U.S. National Library of Medicine’s Genetics Home Reference.

When production of this DNA sequence spirals out of control, severe damage to the brain’s cerebellum and the spinal cord can result.

People with a family history of Friedreich’s ataxia are at greater risk of inheriting this disease. If the defective gene is only passed down from one parent, the person becomes a carrier of the disease but usually doesn’t experience symptoms of it.

Diagnosing Friedreich’s ataxia

Your doctor will look at your medical history and perform a complete physical exam. This will include a detailed neuromuscular exam.

The exam will focus on checking for problems with your nervous system. The signs of damage include poor balance, lack of reflexes, and a lack of sensation in your arms and legs that may spread to other parts of the body, including joints.

Your doctor may also order a CT or MRI scan. These tests provide images of your brain and spinal cord that help to rule out other neurological conditions. You might also have regular X-rays of your head, spine, and chest taken.

Genetic testing can show if you have the defective frataxin gene that causes Friedreich’s ataxia.

Your doctor might also order electromyography to measure the electrical activity in your muscle cells. A nerve conduction study may be done to see how quickly your nerves send impulses.

Your doctor might want you to have an eye exam to check your optic nerve for signs of damage. In addition, your doctor may do echocardiograms and electrocardiograms to diagnose heart disease.

Treatment of Friedreich’s ataxia

Friedreich’s ataxia can’t be cured. Your doctor will treat underlying conditions and symptoms instead. In 2023, the FDA approved omaveloxolone (Skyclarys) as a treatment for Friedrich’s ataxia that improves muscle and nerve function.

Physical therapy and speech therapy can help you function. You may also require walking aids to help you move around.

Braces and other orthopedic devices or surgery might be necessary if you develop a curved spine or problems with your feet. Medications may be used to treat heart disease and diabetes.

Outlook if diagnosed with Friedreich’s ataxia

Over time, Friedreich’s ataxia becomes worse. About 15 to 20 years after symptoms emerge, many people with Friedreich’s ataxia have to rely on a wheelchair. Those who have advanced ataxia might not be able to get around at all.

Heart disease is the leading cause of death among people with Friedreich’s ataxia. It usually becomes fatal by early adulthood. People with mild ataxia symptoms generally live longer.

Late-onset Friedreich’s ataxia, which is when the disorder emerges at age 25 or over, tends to be milder and characterized by slower decline.

Friedreich’s ataxia leads to diabetes in about 10 percent of people who have it. Other complications include heart failure, scoliosis, and difficulty digesting carbohydrates.

Prevention of Friedreich’s ataxia

There’s no way to prevent Friedreich’s ataxia. Since the condition is inherited, genetic counseling and screening are recommended if you have the disease and plan on having children.

A counselor can give you an estimate of your child’s chances of having the disease or carrying the gene without showing symptoms.

FAQ

What is the life expectancy of someone with Friedreich’s ataxia?

Though Friedreich’s ataxia tends to shorten the life expectancy of people who have it, many people live to their 30s and some even to their 60s or later.

What triggers Friedreich’s ataxia?

There are no known triggers for Friedreich’s ataxia, and the onset of the disease may occur at any time in life, most often before the age of 25.

Can a person recover from ataxia?

Friedreich’s ataxia is a degenerative disease with no cure. Physicians who treat people living with this condition can address the symptoms with the FDA-approved medication omaveloxolone, but the condition gradually worsens over time.

Can you still drive if you have ataxia?

Progressive ataxia can eventually impair your ability to drive. Some people living with ataxia may be able to continue driving longer using specially designed hand-controlled vehicles for people with disabilities.

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Box H, et al. (2005). The patient's journey: the progressive ataxias.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1273458/
FDA approves first treatment for Friedreich’s ataxia. (2023).https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-first-treatment-friedreichs-ataxia
Friedreich ataxia. (2021).https://medlineplus.gov/genetics/condition/friedreich-ataxia/
Friedreich ataxia. (2023).https://rarediseases.info.nih.gov/diseases/6468/friedreich-ataxia
Friedreich’s ataxia: Signs and symptoms. (n.d.).https://www.mda.org/disease/friedreichs-ataxia/signs-and-symptoms
O'Hanlon T. (2015). I wish I’d done this ages ago!https://www.fan.asn.au/?p=650
Types. (2021).https://www.nhs.uk/conditions/ataxia/symptoms/

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Medically reviewed by Megan Soliman, MD — Written by Amanda Delgado — Updated on January 18, 2024

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