title: Consequences of the delayed diagnosis of ataxia-telangiectasia.
abstract: OBJECTIVE
  Ataxia-telangiectasia (AT) is a rare, autosomal recessive neurodegenerative disorder in which the diagnosis is obvious when ataxia and telangiectasia are both present. However, the diagnosis can be made upon the onset of ataxia and before the appearance of telangiectasia if confirmed by laboratory tests. Early diagnosis is important for genetic counseling, appropriate care, and avoidance of unnecessary tests. The purpose of this study is to identify factors responsible for delays in the diagnosis of AT.
  
  
  METHODS
  The records of all patients seen at the Ataxia-Telangiectasia Clinical Center from July 1, 1995 to April 1, 1997 were reviewed to determine age of onset of gait abnormality, recognition of telangiectasia, and diagnosis.
  
  
  RESULTS
  In 48 patients with AT, who were the index cases in their respective families, the median age of diagnosis (78 months) occurred after the onset of gait abnormalities (15 months) and closely corresponded to the development of telangiectasia (72 months). In the majority of cases (34/48), telangiectasia appeared before the diagnosis was established. The most common misdiagnosis was cerebral palsy (29/48 cases). Twenty-one children (4 with AT) were born after the start of symptoms in the index case, but before the establishment of a diagnosis.
  
  
  CONCLUSIONS
  The term AT, although a concise and memorable label for the disorder, is also a barrier to early diagnosis. We recommend the use of routine serum alpha-fetoprotein testing for all children with persistent ataxia.
authors.affiliation: Ataxia-Telangiectasia Clinical Center, Johns Hopkins Children's Center, Baltimore, MD 21287-3923, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Cabana
authors.forename: T O
authors.initials: TO
authors.lastname: Crawford
authors.forename: J A
authors.initials: JA
authors.lastname: Winkelstein
authors.forename: J R
authors.initials: JR
authors.lastname: Christensen
authors.forename: H M
authors.initials: HM
authors.lastname: Lederman
mesh_terms: D000293:Adolescent; D001260:Ataxia Telangiectasia / Q000175:diagnosis* / Q000235:genetics / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D002869:Chromosome Aberrations / Q000235:genetics; D025063:Chromosome Disorders; D003951:Diagnostic Errors; D005260:Female; D005808:Genes, Recessive / Q000235:genetics; D005817:Genetic Counseling; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010348:Patient Care Team; D012189:Retrospective Studies; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins