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RFC1 CANVAS: the expanding phenotype
  1. Mary M Reilly
  1. UCL Queen Square Institute of Neurology, University College London, London, UK
  1. Correspondence to Professor Mary M Reilly, UCL Queen Square Institute of Neurology, University College London, London WC1E 6BT, UK; m.reilly{at}

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The phenotype associated with the replication factor C subunit 1 gene (RFC1) expansion is broadening to include Parkinsonism especially when multiple systems atrophy (MSA) is suspected.

In 2019, a recessive pentanucleotide intronic repeat expansion in the RFC1 gene was identified as the cause of the late-onset neurodegenerative disease cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS).1 Subsequent detailed genotype/phenotype studies have confirmed the main phenotype as a large fibre sensory ataxic neuropathy with cerebellar and vestibular involvement with onset usually from the fifth decade. A preceding chronic cough is common and other features include autonomic involvement and occasionally brisk reflexes. In the paper by Sullivan et al, the authors report the RFC1 expansion in three patients with cerebellar ataxia, parkinsonism and autonomic dysfunction (and neuropathy in 2/3) out of a total of 207 …

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  • Contributors This is an invited editorial commentary, which is my sole work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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    Roisin Sullivan Wai Yan Yau Viorica Chelban Salvatore Rossi Natalia Dominik Emer O'Connor John Hardy Nicholas Wood Andrea Cortese Henry Houlden