Spinocerebellar ataxia type 10 (SCA10) is a rare, inherited neurological disease caused by an expansion of the non-coding ATTCT pentanucleotide repeat in the ATAXIN 10 gene. It is characterized by cerebellar ataxia and epilepsy. Previous research has demonstrated extensive white and gray matter degeneration, particularly in the cerebellum. However, the impact of the SCA10 mutation on functional connectivity (FC) remains unexplored. This study aimed to characterize intrinsic FC changes in SCA10 patients and their relationship to clinical manifestations. Structural and resting-state Magnetic Resonance Imaging (MRI) were obtained from 26 SCA10 patients and 26 control subjects. Voxel-based morphometry (VBM) and seed-ROI and Independent Components Analysis (ICA) were performed to identify cerebral atrophy and FC changes respectively. Additionally, correlation analyses were conducted between FC changes and scores from the Scale for the Assessment and Rating of Ataxia (SARA) and the Montreal Cognitive Assessment (MoCA). In SCA10 patients, VBM analysis revealed extensive gray matter loss in motor cortices and the cerebellum. FC analysis identified significant FC changes originating from seed-ROIs in the right cerebellar VI and left precentral gyrus. Furthermore, group comparison using ICA components showed that SCA10 patients exhibited higher FC in the sensorimotor and cerebellar functional networks. Moreover, the average Blood Oxygen Level Dependent (BOLD) signal within the cerebellar network negatively correlated with MoCA scores. In summary, SCA10 patients exhibited enhanced FC in brain regions that displayed gray matter atrophy, underscoring the impact of SCA10 degeneration on resting state networks and induction of potential maladaptive FC compensatory mechanisms. The online version contains supplementary material available at 10.1007/s11682-026-01091-4.

Spinocerebellar ataxia type 10 (SCA10) is an autosomal-dominant disorder caused by intronic expansions of pentanucleotide repeats in the ATXN10 gene. While various repeat motifs have been described, emerging evidence suggests that specific repeat motifs, rather than repeat length alone, can modify disease features such as seizure prevalence and penetrance. We used a novel multiplex 20-gene panel with Cas9-targeted, amplification-free long-read sequencing (LRS) and optical genome mapping to elucidate ATXN10 repeat motif patterns and investigated genotype-phenotype correlations in index cases of 6 multigenerational SCA10 kindreds from Peru. We detected ATXN10 repeat expansions ranging from 990 to 2,002 pentanucleotide repeats (4.9-10 kb) across 6 families. It is important to note that we identified 3 mixed repeat motif patterns and ratios of (ATTCT)n(ATTCC)n, which were associated with differences in age at disease onset and anticipation. Our key novel finding is the prominence of the alternate ATTCC motif alongside the common ATTCT motif. While repeat length alone does not appear to drive disease onset in SCA10, we uncovered that the ratio of the ATTCC motif within distinct repeat patterns might correlate with disease onset. These findings underscore the need to adapt LRS clinical workflows to fully characterize large repeat expansions at the nucleotide level.

Spinocerebellar ataxia type 10 (SCA10), due to an ATTCT repeat expansion in ATXN10, has variable expressivity and the role of presence (ATTCTint +) and absence (ATTCTint-) of interruptions in the repeat is not clear. We aimed to describe the relations between ATTCTint + and age at onset, seizures, and neurologic severity in ataxic and non-ataxic carriers from Brazil. Family, age at onset (AO), and seizures data plus DNA were obtained from symptomatic carriers already diagnosed in Porto Alegre, Curitiba, and São Paulo, Brazil. Patients and their relatives were invited to be evaluated through Scale of Assessment and Rating of Ataxia (SARA) and other clinical scales; a SARA > 2.5 classified subjects as ataxic carriers. Repeat-primed PCR (RP-PCR) defined the expansions with (ATTCTint +) or without (ATTCTint-) interruptions. Comparisons were performed for a p level of 0.05. Among 78 ataxic carriers, earlier AO (p = 0.039) and higher occurrences of epilepsy (p < 0.0001) were seen in subjects with ATTCTint + than in those with ATTCTint-. Clinical scales were worse in 34 ataxics than in 7 non-ataxics and 10 related controls (p = 0.006) and did not discriminate non-ataxics from controls. The 11 ataxic ATTCTint + carriers had higher SARA scores per year of disease duration than the 23 ATTCTint- carriers (r = 0.879, beta = 0.45, p = 0.0001). ATTCTint + carriers had worse clinical findings than ATTCTint- carriers: earlier AO, more seizures, and worse ataxia scores. Interruptions in the expanded repeat have a real impact in SCA10 phenotype.

Spinocerebellar ataxia type 10 (SCA10) is an autosomal dominant cerebellar ataxia, characterized by epilepsy, ataxic symptoms, and cognitive impairments linked to Cerebellar Cognitive Affective Syndrome (CCAS). The Cerebellar Cognitive Affective Syndrome Scale (CCAS-S) has been developed to identify CCAS across various cerebellar pathologies. To determine whether patients with SCA10 exhibit CCAS using the CCAS-S, and to compare its effectiveness with the Montreal Cognitive Assessment (MoCA). A secondary objective was to evaluate the effect of demographic and clinical data on CCAS-S performance. Fifteen patients with SCA10 and fifteen matched controls underwent assessments using the CCAS-S, the MoCA, the Scale for the Assessment and Rating of Ataxia (SARA), and the Center for Epidemiologic Studies Depression Scale (CES-D). Diagnostic accuracy was analyzed using ROC curve analysis, comparing total and subcategory scores between groups. Demographic and clinical data were examined for relations with CCAS-S scores. The CCAS-S effectively distinguished cognitive impairments in SCA10 patients, showing satisfactory sensitivity and specificity (AUC of 0.83). Although no significant differences were found in the AUCs between CCAS-S and MoCA (p =  0.45), the CCAS-S demonstrated a significantly larger effect size in the comparison between patients and control group (d =  2.33). Cognitive performance was poorer in patients than in controls (p =  < 0.001), with depressive symptoms and age having a significant impact on CCAS-S outcomes. Patients with the SCA10 mutation exhibit CCAS. Besides the significant cognitive impairment, also detected by MoCA, the CCAS-S score was significantly affected by indicators of depressive mood and age, highlighting the importance of considering these variables during outcome analyses.