Is weight loss common in patients with Cerebellar Ataxia, Neuropathy, and Vestibular Areflexia Syndrome (CANVAS) ataxia?

Weight Loss in CANVAS Ataxia

Weight loss is not a commonly reported feature of Cerebellar Ataxia, Neuropathy, and Vestibular Areflexia Syndrome (CANVAS), though nutritional challenges may develop as the disease progresses.

Clinical Features of CANVAS

CANVAS is characterized by a triad of symptoms:

• Cerebellar ataxia (affecting gait and limb coordination)
• Sensory neuropathy (particularly affecting vibration sense)
• Bilateral vestibular areflexia (causing balance impairment)

The typical presentation includes:

• Progressive balance impairment
• Sensory disturbances in the lower limbs
• Gait and limb ataxia
• Positive Romberg sign
• Cerebellar dysarthria
• Gaze-evoked nystagmus
• Absent deep tendon reflexes
• Impaired vibratory sensation 1
• Abnormal visually enhanced vestibulo-ocular reflex (hallmark finding) 2

Nutritional Considerations in CANVAS

While weight loss is not specifically reported as a common symptom in CANVAS, several factors may potentially affect nutritional status as the disease progresses:

1. Dysphagia: As with other cerebellar disorders, dysphagia may develop due to cerebellar dysarthria and incoordination of swallowing muscles 3

2. Increased Energy Expenditure: Ataxic movements may potentially increase energy expenditure, though this is not specifically documented for CANVAS

3. Additional Symptoms: Some CANVAS patients may also present with:

   • Chronic cough
   • Orthostatic hypotension
   • Neuropathic pain 2

Nutritional Monitoring and Management

Although CANVAS-specific nutritional guidelines are not available, principles from other neurological disorders suggest:

• Regular monitoring of nutritional status and body weight is recommended for patients with neurological disorders 4, 5

• Early detection and management of dysphagia is important to prevent aspiration and maintain adequate nutrition 4

• Nutritional assessment should be conducted at least yearly and whenever clinical conditions change 4

Clinical Implications

• Falls risk management and dysphagia assessment are major clinical priorities in CANVAS 2

• CANVAS is a progressive disorder that can severely affect patients' quality of life 6

• The disease typically has a slowly progressive course with stereotypical presentation 6

• Supportive interventions including nutritional counseling may be beneficial, as in other cerebellar ataxias 3

Conclusion

While weight loss is not specifically highlighted as a common feature of CANVAS in the available literature, clinicians should monitor nutritional status as part of comprehensive care, particularly as dysphagia and increased energy expenditure from ataxic movements may potentially affect nutritional status as the disease progresses.