title: Neurological outcome in cerebrotendinous xanthomatosis treated with chenodeoxycholic acid: early versus late diagnosis.
abstract: OBJECTIVE
  To present the long-term neurological outcome of Jewish Israeli patients with cerebrotendinous xanthomatosis (CTX) after several years of chenodeoxycholic acid (CDCA) treatment.
  
  
  METHODS
  A cross sectional observational study of all patients with a diagnosis of CTX followed in a referral outpatient clinic during the years 2003-2012.
  
  
  RESULTS
  Eighteen patients (10 men) from 11 families were enrolled. Sixteen patients were included in the analysis (2 patients had low compliance for treatment). The mean ± SD age at last evaluation was 35.0 ± 9.2 years (range, 16-45 years). After their diagnosis, at age 22.6 ± 10.8 years, all patients were treated with CDCA. Patients who started treatment after the age of 25 years had worse outcome and were significantly more limited in ambulation (P = 0.004) and more cognitively impaired (P = 0.047). Five patients who started treatment after 25 years of age continued to deteriorate despite CDCA treatment.
  
  
  CONCLUSIONS
  Beginning CDCA treatment as early as possible is crucial to preventing neurological damage and deterioration in CTX. After significant neurological pathology is established, the effect of treatment is limited and deterioration may continue.
authors.affiliation: The Parkinson Disease and Movement Disorders Clinic, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Gilad
authors.initials: G
authors.lastname: Yahalom
authors.forename: Rakefet
authors.initials: R
authors.lastname: Tsabari
authors.forename: Noa
authors.initials: N
authors.lastname: Molshatzki
authors.forename: Lilach
authors.initials: L
authors.lastname: Ephraty
authors.forename: Hofit
authors.initials: H
authors.lastname: Cohen
authors.forename: Sharon
authors.initials: S
authors.lastname: Hassin-Baer
mesh_terms: D000293:Adolescent; D000328:Adult; D002635:Chenodeoxycholic Acid / Q000627:therapeutic use*; D053493:Cholestanetriol 26-Monooxygenase / Q000235:genetics; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D042241:Early Diagnosis; D004522:Educational Status; D004651:Employment; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D008875:Middle Aged; D009154:Mutation; D009422:Nervous System Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D019294:Xanthomatosis, Cerebrotendinous / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D005765:Gastrointestinal Agents; D002635:Chenodeoxycholic Acid; C506831:CYP27A1 protein, human; D053493:Cholestanetriol 26-Monooxygenase