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[[File:Brain-cerebellum.png|alt=|thumb|Cerebellum (blue) of the human brain.]]
'''Cerebellar''' '''degeneration''' is a process in which [[Neuron|neurons]] in the [[cerebellum]] deteriorate and die. <ref>{{Cite web|url=https://www.ninds.nih.gov/Disorders/All-Disorders/Cerebellar-Degeneration-Information-Page#disorders-r1|title=Cerebellar Degeneration Information Page {{!}} National Institute of Neurological Disorders and Stroke|website=www.ninds.nih.gov|access-date=2018-09-28}}</ref> This condition may not only affect the cerebellum, but also other areas of the central nervous system, such as the [[spinal cord]], the [[cerebral cortex]], and the [[brainstem]]. <ref>{{Cite news|url=https://rarediseases.org/rare-diseases/cerebellar-degeneration-subacute/|title=Cerebellar Degeneration, Subacute - NORD (National Organization for Rare Disorders)|work=NORD (National Organization for Rare Disorders)|access-date=2018-09-28|language=en-US}}</ref>
'''Cerebellar''' '''degeneration''' is a process in which [[Neuron|neurons]] in the [[cerebellum]] deteriorate and die.<ref>{{Cite web|url=https://www.ninds.nih.gov/Disorders/All-Disorders/Cerebellar-Degeneration-Information-Page#disorders-r1|title=Cerebellar Degeneration Information Page {{!}} National Institute of Neurological Disorders and Stroke|website=www.ninds.nih.gov|access-date=2018-09-28}}</ref> There are two types of cerebellar degeneration; [[paraneoplastic cerebellar degeneration]], preceding the diagnosis of cancer; and alcoholic or nutritional cerebellar degeneration, caused by a deficiency of the vitamin [[thiamine]].<ref name=":0">{{Cite news|url=https://rarediseases.org/rare-diseases/cerebellar-degeneration-subacute/|title=Cerebellar Degeneration, Subacute - NORD (National Organization for Rare Disorders)|work=NORD (National Organization for Rare Disorders)|access-date=2018-09-28|language=en-US}}</ref> As the cerebellum contributes to the coordination and regulation of motor activities of the human body, any degeneration to this part of the organ can be life-threatening, resulting in disorders in fine movement, posture, and motor learning in humans. This condition may not only cause cerebellar damage on a temporary or permanent basis, but can also affect other areas of the [[central nervous system]], such as the [[spinal cord]], the [[cerebral cortex]], and the [[brainstem]].<ref name=":0" />
⚫
[[File:Cerebellar Degeneration.png|thumb|MRI scans of two brains. The brain on the left shows atrophy of the cerebellum in a person with cerebellar degeneration. The brain on the right shows a normal cerebellum]]

Cerebellar degeneration is associated with a variety of [[inherited]] and non-inherited conditions. Thus, it can be classified as [[Autosomal Recessive|autosomal recessive]], [[autosomal dominant]], [[X-linked]], or [[Mitochondrial disease|mitochondrial]]. However, cerebellar degeneration can also be classified according conditions that an individual may acquire during their lifetime, including infectious, metabolic, [[Autoimmunity|autoimmune]], [[Paraneoplastic cerebellar degeneration|paraneoplastic]], nutritional or toxic triggers.<ref name=":2">{{Cite news|url=https://www.clinicaladvisor.com/hospital-medicine/cerebellar-degeneration/article/599803/|title=Cerebellar degeneration|date=2016-12-20|work=Clinical Advisor|access-date=2018-10-02|language=en}}</ref>

== Causes ==
Cerebellar degeneration can be caused by a variety of inherited or acquired (non-genetic and non-inherited) conditions, including neurological diseases, paraneoplastic disorders, nutritional deficiency, and chronic alcohol abuse.<ref>{{Cite web|url=http://neuropathology-web.org/chapter9/chapter9hAtaxia.html|title=Ataxia and cerebellar degeneration|last=M.D.|first=Dimitri Agamanolis,|website=neuropathology-web.org|access-date=2018-10-02}}</ref>

=== Neurological diseases ===
[[Neurological diseases]] refers to any disorder of the nervous system, including structural, biochemical or electrical abnormalities of the brain, spinal cord or other nerves. Neurological diseases that can cause cerebellar degeneration include: <ref name=":1">{{Cite web|url=https://rarediseases.info.nih.gov/diseases/6019/cerebellar-degeneration#ref_681|title=Cerebellar degeneration {{!}} Genetic and Rare Diseases Information Center (GARD) – an NCATS Program|website=rarediseases.info.nih.gov|language=en|access-date=2018-10-02}}</ref>

==== '''Inherited:''' ====

* [[Spinocerebellar ataxia|Spinocerebellar ataxia (SCA)]] (also known as spinocerebellar atrophy or spinocerebellar degeneration), which refers to a group of conditions caused by mutations in many different genes and characterised by degenerative changes of the cerebellum, brain stem, and spinal cord.<ref>{{Cite web|url=https://rarediseases.info.nih.gov/diseases/10748/spinocerebellar-ataxia|title=Spinocerebellar ataxia {{!}} Genetic and Rare Diseases Information Center (GARD) – an NCATS Program|website=rarediseases.info.nih.gov|language=en|access-date=2018-10-02}}</ref>
* [[Multiple sclerosis|Multiple sclerosis (MS)]], caused by the interaction of multiple genetic and environmental factors<ref name=":1" /> and occurring when the myelin sheath of the nerve cells becomes damaged.<ref>{{Cite news|url=https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/multiple-sclerosis-ms|title=Multiple sclerosis (MS)|last=Services|first=Department of Health & Human|access-date=2018-10-02|language=en}}</ref>

==== Non-inherited: ====

* [[Transmissible spongiform encephalopathy|Transmissible spongiform encephalopathies (TSEs)]] (also known as prion diseases), which refers to a group of diseases associated with inflammation of the brain, particularly in the cerebellum, caused by the presence of abnormal proteins.<ref>{{Cite news|url=https://www.efsa.europa.eu/en/topics/topic/transmissible-spongiform-encephalopathies-tses|title=Transmissible Spongiform Encephalopathies (TSEs)|work=European Food Safety Authority|access-date=2018-10-02|language=en}}</ref>
* [[Hemorrhagic stroke|Acute & hemorrhagic stroke]], resulting in the death of neurons in the cerebellum due to a disrupted flow of oxygen to the brain.<ref>{{Cite web|url=https://strokefoundation.org.au/About-Stroke|title=About Stroke — Stroke Foundation - Australia|website=strokefoundation.org.au|language=en|access-date=2018-10-02}}</ref>

=== '''Paraneoplastic disorders''' ===
[https://rarediseases.info.nih.gov/diseases/9415/paraneoplastic-neurologic-disorders Paraneoplastic disorders] are a group of non-inherited degenerative conditions that are triggered by a person's immune system response to a cancerous tumor. These disorders occur when cancer-fighting antibodies or [[T cell|T-cells]] (white blood cells) begin to attack normal cells in the nervous system rather than cancerous cells,<ref name=":0" /> resulting in degeneration of neurons in the cerebellum.

=== Nutritional deficiency & c'''hronic alcohol abuse''' ===
[[Nutritional deficiency]] and [https://bestpractice.bmj.com/topics/en-us/824 chronic alcohol abuse] are two non-inherited conditions that lead to impaired absorption or utilisation of the vitamin [[thiamine]] (B-1), thus causing temporary or permanent damage to cerebellar cells.<ref name=":0" /> Alcohol-related cerebellar degeneration is one of the common causes of acquired cerebellar ataxia.<ref>{{Cite journal|last=Shanmugarajah|first=Priya D.|last2=Hoggard|first2=Nigel|last3=Currie|first3=Stuart|last4=Aeschlimann|first4=Daniel P.|last5=Aeschlimann|first5=Pascale C.|last6=Gleeson|first6=Dermot C.|last7=Karajeh|first7=Mohammed|last8=Woodroofe|first8=Nicola|last9=Grünewald|first9=Richard A.|date=2016-10-03|title=Alcohol-related cerebellar degeneration: not all down to toxicity?|url=https://cerebellumandataxias.biomedcentral.com/articles/10.1186/s40673-016-0055-1|journal=Cerebellum & Ataxias|language=En|volume=3|issue=1|doi=10.1186/s40673-016-0055-1|issn=2053-8871|pmc=PMC5048453|pmid=27729985}}</ref>

== Signs and Symptoms ==
Patients suffering from cerebellar degeneration experience a loss of nerve cells ([[Purkinje cell|Purkinje cells]]) throughout the cerebellum, as well as an elevated protein level and high volume of lymph cells within the [[cerebrospinal fluid]], causing swelling and enlargement of the brain. The most characteristic signs and symptoms experienced by patients with cerebellar degeneration include:<ref name=":0" /><ref name=":1" />

* a wide-based, uncoordinated, lurching walk
* a back and forth tremor in the trunk of the body
* jerky arm and leg movements (especially of the arms in paraneoplastic cerebellar degeneration and of the legs in alcoholic/nutritional cerebellar degeneration)
* [[dysarthria]] (difficulty in articulating speech, especially noticeable in paraneoplastic cerebellar degeneration)
* [[dysphagia]] (difficulty in swallowing)
* [[vertigo]] (dizziness)
* [[nystagmus]] (rapid, involuntary eye movements)
* [[Ophthalmoparesis|ophthalmoplegia]] (paralysis of [[extraocular muscles]])
* [[diplopia]] (double vision)

Scientific studies have revealed that psychiatric symptoms are also common in patients with cerebellar degeneration,<ref>{{Cite web|url=http://www.ninds.nih.gov/news_and_events/news_articles/news_article_cerebellar.htm.|title=Press Releases {{!}} National Institute of Neurological Disorders and Stroke|website=www.ninds.nih.gov|access-date=2018-10-02}}</ref><ref>{{Cite journal|last=Liszewski|first=Christine M.|last2=O'Hearn|first2=Elizabeth|last3=Leroi|first3=Iracema|last4=Gourley|first4=Lisa|last5=Ross|first5=Christopher A.|last6=Margolis|first6=Russell L.|date=2004-02|title=Cognitive Impairment and Psychiatric Symptoms in 133 Patients With Diseases Associated With Cerebellar Degeneration|url=https://neuro.psychiatryonline.org/doi/full/10.1176/jnp.16.1.109|journal=The Journal of Neuropsychiatry and Clinical Neurosciences|language=en|volume=16|issue=1|pages=109–112|doi=10.1176/jnp.16.1.109|issn=0895-0172}}</ref><ref>{{Cite journal|last=Phillips|first=Joseph R.|last2=Hewedi|first2=Doaa H.|last3=Eissa|first3=Abeer M.|last4=Moustafa|first4=Ahmed A.|date=2015-05-05|title=The Cerebellum and Psychiatric Disorders|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419550/|journal=Frontiers in Public Health|volume=3|doi=10.3389/fpubh.2015.00066|issn=2296-2565|pmc=PMC4419550|pmid=26000269}}</ref> where dementia is a typical psychiatric disorder resulting from cerebellar damage. Approximately 50% of all patients suffer from dementia as a result of paraneoplastic cerebellar degeneration.<ref name=":0" />

== Diagnosis ==
⚫
[[File:Cerebellar_Degeneration.png|link=https://en.wikipedia.org/wiki/File:Cerebellar_Degeneration.png|alt=|thumb|295x295px|MRI scans of two brains. The brain on the left shows atrophy of the cerebellum in a person with cerebellar degeneration. The brain on the right shows a normal cerebellum.]]
In order to select an appropriate and accurate [[Medical test|diagnostic test]] for cerebellar degeneration, it is crucial that a range of factors specific to each patient are taken into consideration. These include; the patient's age, acuity of their signs and symptoms, associated neurological conditions, and family history of hereditary forms of cerebellar degeneration.<ref name=":2" /> A diagnosis of cerebellar degeneration is suspected when any of the aforementioned signs and symptoms surface. For hereditary forms of cerebellar degeneration, [[genetic testing]] can be carried out in order to confirm the diagnosis, if the disease-causing gene for that particular condition is known.<ref name=":3">{{Cite news|url=https://rarediseases.org/rare-diseases/autosomal-dominant-hereditary-ataxia/|title=Autosomal Dominant Hereditary Ataxia - NORD (National Organization for Rare Disorders)|work=NORD (National Organization for Rare Disorders)|access-date=2018-10-04|language=en-US}}</ref> For instance, genetic testing is available for genes that are known to cause spinocerebellar ataxia, which is a hereditary cause of cerebellar degeneration.<ref name=":3" /> In saying this, for most conditions known to cause cerebellar degeneration, the genetic cause is unknown, hence these patients can not proceed with genetic testing.<ref>{{Cite web|url=https://www.ninds.nih.gov/Disorders/All-Disorders/Cerebellar-Degeneration-Information-Page|title=Cerebellar Degeneration Information Page {{!}} National Institute of Neurological Disorders and Stroke|website=www.ninds.nih.gov|access-date=2018-10-04}}</ref> In cases where cerebellar degeneration is acquired, a diagnosis can be established using imaging methods such as [[Magnetic resonance imaging|magnetic resonance imaging (MRI)]] and [[CT scan|computerised tomography (CT scans)]], necessary to identify brain abnormalities in people with cerebellar degeneration.<ref>{{Cite web|url=http://www.uptodate.com/contents/the-spinocerebellar-ataxias.|title=UpToDate|website=www.uptodate.com|access-date=2018-10-04}}</ref>

== Treatment ==
Treatment for cerebellar degeneration varies depending on the underlying cause, unique to each patient. There is currently no cure for hereditary forms of cerebellar degeneration, though it can be managed. In these cases, immediate management of inherited cerebellum damage should involve consultation with a [[Neurology|neurologist]], followed by specific management approaches based on the signs and symptoms experienced by each unique patient.<ref name=":2" /> These management approaches aim to provide [[Therapy|supportive care]] to the patient, consisting of [[physical therapy]] to strengthen muscles, [[occupational therapy]], and [[speech pathology]]. Long-term management of inherited cerebellar degeneration involves an ongoing commitment to supportive care therapies, as well as a longitudinal relationship with a neurologist. In some instances adjustments need to be made in the patients home, to improve accessibility and mobility in and around their living environment, to optimise safety.<ref name=":2" />

For non-genetic, non-hereditary forms of cerebellar degeneration, some signs and symptoms can be reversed by treating the fundamental cause.<ref>{{Cite news|url=https://www.merckmanuals.com/professional/neurologic-disorders/movement-and-cerebellar-disorders/cerebellar-disorders|title=Cerebellar Disorders - Neurologic Disorders - Merck Manuals Professional Edition|work=Merck Manuals Professional Edition|access-date=2018-10-04|language=en-US}}</ref> For instance, the signs and symptoms of paraneoplastic cerebellar degeneration can be managed by intially treating the underlying cancer. In cases of nutritional or alcoholic cerebellar degeneration, symptoms of these conditions can be relieved by initially consuming a balanced diet and discontinuing the consumption of alcohol respectively, followed by [[Dietary supplement|dietary supplementation]] with thiamine.<ref name=":0" />

== Prognosis ==
The long-term outlook for patients suffering from cerebellar degeneration differs depending on the underlying cause.<ref>{{Cite web|url=https://www.ninds.nih.gov/Disorders/All-Disorders/Ataxias-and-Cerebellar-or-Spinocerebellar-Degeneration-Information-Page|title=Ataxias and Cerebellar or Spinocerebellar Degeneration Information Page {{!}} National Institute of Neurological Disorders and Stroke|website=www.ninds.nih.gov|access-date=2018-10-04}}</ref> Each inherited or acquired disease that results in cerebellar degeneration has its own specific prognosis, however most are generally [[Progressive disease|progressive]].<ref name=":2" />

== Epidemiology ==
Cerebellar degeneration continues to carry a considerable burden on the health of the world population, as well as on health agencies and governing bodies across the globe. Cerebellum-related disorders generally transpire in individuals at middle age, however the age of symptomatic onset varies depending on the underlying cause of the degenerative disorder.<ref>{{Cite web|url=https://www.ninds.nih.gov/News-Events/News-and-Press-Releases/Press-Releases|title=Press Releases {{!}} National Institute of Neurological Disorders and Stroke|website=www.ninds.nih.gov|access-date=2018-10-04}}</ref> In paraneoplastic cerebellar degeneration, the average age of onset is 50, often affecting more males than females.<ref name=":0" /> Nutritional and alcoholic cerebellar degeneration, being more prevalent than paraneoplastic cerebellar degeneration, affects individuals with a thiamine deficiency and alcoholics, respectively.<ref name=":0" /> Recent global [[Epidemiology|epidemiological studies]] on cerebellar degeneration reported an estimated prevalence rate of 26 per 100,000 in children.<ref>{{Cite journal|last=Salman|first=Michael S.|date=2018-2|title=Epidemiology of Cerebellar Diseases and Therapeutic Approaches|url=https://www.ncbi.nlm.nih.gov/pubmed/28940047|journal=Cerebellum (London, England)|volume=17|issue=1|pages=4–11|doi=10.1007/s12311-017-0885-2|issn=1473-4230|pmid=28940047}}</ref>


== References ==
== References ==

Revision as of 10:06, 4 October 2018

Cerebellum (blue) of the human brain.

Cerebellar degeneration is a process in which neurons in the cerebellum deteriorate and die.[1] There are two types of cerebellar degeneration; paraneoplastic cerebellar degeneration, preceding the diagnosis of cancer; and alcoholic or nutritional cerebellar degeneration, caused by a deficiency of the vitamin thiamine.[2] As the cerebellum contributes to the coordination and regulation of motor activities of the human body, any degeneration to this part of the organ can be life-threatening, resulting in disorders in fine movement, posture, and motor learning in humans. This condition may not only cause cerebellar damage on a temporary or permanent basis, but can also affect other areas of the central nervous system, such as the spinal cord, the cerebral cortex, and the brainstem.[2]

Cerebellar degeneration is associated with a variety of inherited and non-inherited conditions. Thus, it can be classified as autosomal recessive, autosomal dominant, X-linked, or mitochondrial. However, cerebellar degeneration can also be classified according conditions that an individual may acquire during their lifetime, including infectious, metabolic, autoimmune, paraneoplastic, nutritional or toxic triggers.[3]

Causes

Cerebellar degeneration can be caused by a variety of inherited or acquired (non-genetic and non-inherited) conditions, including neurological diseases, paraneoplastic disorders, nutritional deficiency, and chronic alcohol abuse.[4]

Neurological diseases

Neurological diseases refers to any disorder of the nervous system, including structural, biochemical or electrical abnormalities of the brain, spinal cord or other nerves. Neurological diseases that can cause cerebellar degeneration include: [5]

Inherited:

  • Spinocerebellar ataxia (SCA) (also known as spinocerebellar atrophy or spinocerebellar degeneration), which refers to a group of conditions caused by mutations in many different genes and characterised by degenerative changes of the cerebellum, brain stem, and spinal cord.[6]
  • Multiple sclerosis (MS), caused by the interaction of multiple genetic and environmental factors[5] and occurring when the myelin sheath of the nerve cells becomes damaged.[7]

Non-inherited:

Paraneoplastic disorders

Paraneoplastic disorders are a group of non-inherited degenerative conditions that are triggered by a person's immune system response to a cancerous tumor. These disorders occur when cancer-fighting antibodies or T-cells (white blood cells) begin to attack normal cells in the nervous system rather than cancerous cells,[2] resulting in degeneration of neurons in the cerebellum.

Nutritional deficiency & chronic alcohol abuse

Nutritional deficiency and chronic alcohol abuse are two non-inherited conditions that lead to impaired absorption or utilisation of the vitamin thiamine (B-1), thus causing temporary or permanent damage to cerebellar cells.[2] Alcohol-related cerebellar degeneration is one of the common causes of acquired cerebellar ataxia.[10]

Signs and Symptoms

Patients suffering from cerebellar degeneration experience a loss of nerve cells (Purkinje cells) throughout the cerebellum, as well as an elevated protein level and high volume of lymph cells within the cerebrospinal fluid, causing swelling and enlargement of the brain. The most characteristic signs and symptoms experienced by patients with cerebellar degeneration include:[2][5]

  • a wide-based, uncoordinated, lurching walk
  • a back and forth tremor in the trunk of the body
  • jerky arm and leg movements (especially of the arms in paraneoplastic cerebellar degeneration and of the legs in alcoholic/nutritional cerebellar degeneration)
  • dysarthria (difficulty in articulating speech, especially noticeable in paraneoplastic cerebellar degeneration)
  • dysphagia (difficulty in swallowing)
  • vertigo (dizziness)
  • nystagmus (rapid, involuntary eye movements)
  • ophthalmoplegia (paralysis of extraocular muscles)
  • diplopia (double vision)

Scientific studies have revealed that psychiatric symptoms are also common in patients with cerebellar degeneration,[11][12][13] where dementia is a typical psychiatric disorder resulting from cerebellar damage. Approximately 50% of all patients suffer from dementia as a result of paraneoplastic cerebellar degeneration.[2]

Diagnosis

MRI scans of two brains. The brain on the left shows atrophy of the cerebellum in a person with cerebellar degeneration. The brain on the right shows a normal cerebellum.

In order to select an appropriate and accurate diagnostic test for cerebellar degeneration, it is crucial that a range of factors specific to each patient are taken into consideration. These include; the patient's age, acuity of their signs and symptoms, associated neurological conditions, and family history of hereditary forms of cerebellar degeneration.[3] A diagnosis of cerebellar degeneration is suspected when any of the aforementioned signs and symptoms surface. For hereditary forms of cerebellar degeneration, genetic testing can be carried out in order to confirm the diagnosis, if the disease-causing gene for that particular condition is known.[14] For instance, genetic testing is available for genes that are known to cause spinocerebellar ataxia, which is a hereditary cause of cerebellar degeneration.[14] In saying this, for most conditions known to cause cerebellar degeneration, the genetic cause is unknown, hence these patients can not proceed with genetic testing.[15] In cases where cerebellar degeneration is acquired, a diagnosis can be established using imaging methods such as magnetic resonance imaging (MRI) and computerised tomography (CT scans), necessary to identify brain abnormalities in people with cerebellar degeneration.[16]

Treatment

Treatment for cerebellar degeneration varies depending on the underlying cause, unique to each patient. There is currently no cure for hereditary forms of cerebellar degeneration, though it can be managed. In these cases, immediate management of inherited cerebellum damage should involve consultation with a neurologist, followed by specific management approaches based on the signs and symptoms experienced by each unique patient.[3] These management approaches aim to provide supportive care to the patient, consisting of physical therapy to strengthen muscles, occupational therapy, and speech pathology. Long-term management of inherited cerebellar degeneration involves an ongoing commitment to supportive care therapies, as well as a longitudinal relationship with a neurologist. In some instances adjustments need to be made in the patients home, to improve accessibility and mobility in and around their living environment, to optimise safety.[3]

For non-genetic, non-hereditary forms of cerebellar degeneration, some signs and symptoms can be reversed by treating the fundamental cause.[17] For instance, the signs and symptoms of paraneoplastic cerebellar degeneration can be managed by intially treating the underlying cancer. In cases of nutritional or alcoholic cerebellar degeneration, symptoms of these conditions can be relieved by initially consuming a balanced diet and discontinuing the consumption of alcohol respectively, followed by dietary supplementation with thiamine.[2]

Prognosis

The long-term outlook for patients suffering from cerebellar degeneration differs depending on the underlying cause.[18] Each inherited or acquired disease that results in cerebellar degeneration has its own specific prognosis, however most are generally progressive.[3]

Epidemiology

Cerebellar degeneration continues to carry a considerable burden on the health of the world population, as well as on health agencies and governing bodies across the globe. Cerebellum-related disorders generally transpire in individuals at middle age, however the age of symptomatic onset varies depending on the underlying cause of the degenerative disorder.[19] In paraneoplastic cerebellar degeneration, the average age of onset is 50, often affecting more males than females.[2] Nutritional and alcoholic cerebellar degeneration, being more prevalent than paraneoplastic cerebellar degeneration, affects individuals with a thiamine deficiency and alcoholics, respectively.[2] Recent global epidemiological studies on cerebellar degeneration reported an estimated prevalence rate of 26 per 100,000 in children.[20]

References

  1. ^ "Cerebellar Degeneration Information Page | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Retrieved 2018-09-28.
  2. ^ a b c d e f g h i "Cerebellar Degeneration, Subacute - NORD (National Organization for Rare Disorders)". NORD (National Organization for Rare Disorders). Retrieved 2018-09-28.
  3. ^ a b c d e "Cerebellar degeneration". Clinical Advisor. 2016-12-20. Retrieved 2018-10-02.
  4. ^ M.D., Dimitri Agamanolis,. "Ataxia and cerebellar degeneration". neuropathology-web.org. Retrieved 2018-10-02.{{cite web}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  5. ^ a b c "Cerebellar degeneration | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Retrieved 2018-10-02.
  6. ^ "Spinocerebellar ataxia | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Retrieved 2018-10-02.
  7. ^ Services, Department of Health & Human. "Multiple sclerosis (MS)". Retrieved 2018-10-02.
  8. ^ "Transmissible Spongiform Encephalopathies (TSEs)". European Food Safety Authority. Retrieved 2018-10-02.
  9. ^ "About Stroke — Stroke Foundation - Australia". strokefoundation.org.au. Retrieved 2018-10-02.
  10. ^ Shanmugarajah, Priya D.; Hoggard, Nigel; Currie, Stuart; Aeschlimann, Daniel P.; Aeschlimann, Pascale C.; Gleeson, Dermot C.; Karajeh, Mohammed; Woodroofe, Nicola; Grünewald, Richard A. (2016-10-03). "Alcohol-related cerebellar degeneration: not all down to toxicity?". Cerebellum & Ataxias. 3 (1). doi:10.1186/s40673-016-0055-1. ISSN 2053-8871. PMC 5048453. PMID 27729985.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  11. ^ "Press Releases | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Retrieved 2018-10-02.
  12. ^ Liszewski, Christine M.; O'Hearn, Elizabeth; Leroi, Iracema; Gourley, Lisa; Ross, Christopher A.; Margolis, Russell L. (2004-02). "Cognitive Impairment and Psychiatric Symptoms in 133 Patients With Diseases Associated With Cerebellar Degeneration". The Journal of Neuropsychiatry and Clinical Neurosciences. 16 (1): 109–112. doi:10.1176/jnp.16.1.109. ISSN 0895-0172. {{cite journal}}: Check date values in: |date= (help)
  13. ^ Phillips, Joseph R.; Hewedi, Doaa H.; Eissa, Abeer M.; Moustafa, Ahmed A. (2015-05-05). "The Cerebellum and Psychiatric Disorders". Frontiers in Public Health. 3. doi:10.3389/fpubh.2015.00066. ISSN 2296-2565. PMC 4419550. PMID 26000269.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  14. ^ a b "Autosomal Dominant Hereditary Ataxia - NORD (National Organization for Rare Disorders)". NORD (National Organization for Rare Disorders). Retrieved 2018-10-04.
  15. ^ "Cerebellar Degeneration Information Page | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Retrieved 2018-10-04.
  16. ^ "UpToDate". www.uptodate.com. Retrieved 2018-10-04.
  17. ^ "Cerebellar Disorders - Neurologic Disorders - Merck Manuals Professional Edition". Merck Manuals Professional Edition. Retrieved 2018-10-04.
  18. ^ "Ataxias and Cerebellar or Spinocerebellar Degeneration Information Page | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Retrieved 2018-10-04.
  19. ^ "Press Releases | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Retrieved 2018-10-04.
  20. ^ Salman, Michael S. (2018-2). "Epidemiology of Cerebellar Diseases and Therapeutic Approaches". Cerebellum (London, England). 17 (1): 4–11. doi:10.1007/s12311-017-0885-2. ISSN 1473-4230. PMID 28940047. {{cite journal}}: Check date values in: |date= (help)
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