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Hereditary episodic ataxia (EA) represents a group of neurological disorders characterized by recurrent episodes of ataxia and vertigo which may be progressive. Weakness, dystonia and ataxia are sometimes present in the interictal period. Seven types of EA have been described to date (EA type 1 to EA type 7), but most of the reported cases belong to EA1 and EA2.
No HPO annotations are available for this condition.
Age of onset: newborn period, infancy.
Episodic ataxia type 1 (EA1), first described by , is a potassium channelopathy characterized by constant myokymia and dramatic episodes of spastic contractions of the skeletal muscles of the head, arms, and legs with loss of both motor coordination and balance. Typical attacks in individuals with EA1. In addition to the features noted in , Clinical manifestations, individuals may experience the following symptoms:
No consensus diagnostic criteria for episodic ataxia type 1 (EA1) have been published.
Episodic ataxia type 1 (EA1) should be suspected in individuals with the following clinical, imaging, and laboratory findings.
Clinical manifestations
Episodic attacks of:
Generalized ataxia, loss of balance, and jerking movements of the head, arms, and legs
No approved treatments are currently available for hereditary episodic ataxia. The disease remains an area of unmet medical need.
Evaluations Following Initial Diagnosis To establish the extent of disease and therapeutic needs in an individual diagnosed with episodic ataxia type 1, the evaluations summarized (if not already completed) are recommended. Table 3. Recommended Evaluations Following Initial Diagnosis in Individuals with Episodic Ataxia Type 1
Surveillance should include annual neurologic examination.
Source: GeneReviews — "Episodic Ataxia Type 1"
Estimated prevalence: 1-9 in 100,000 (Uncommon).
1 clinical trial registered, 1 recruiting. Interventions under study include other interventions. Research is primarily sponsored by academic and government institutions.
179 publications have been identified in PubMed for hereditary episodic ataxia. Kisho has analyzed 141 by research type. Research spans Review / Meta-Analysis (28%), Case Report / Case Series (25%), and Basic Science / Preclinical (21%).
Research Type | Count | % of Total |
|---|---|---|
Research summaries | 40 |
Data assembled from 5 of 12 sources · Last updated Sep 18, 2026, 4:32 PM UTC
European rare disease database
Genetic and Rare Diseases Info Center
Vertigo
Diaphoresis
Clumsiness
Difficulty in breathing, which can occur during ataxic episodes or as isolated episodes
Source: GeneReviews — "Episodic Ataxia Type 1"
Dysarthria
Incoordination of hands
Weakness
Tremors
Muscle twitching/stiffening
Dizziness
Stiffening of the body
Blurred vision, diplopia
Nausea, headache, and vomiting
Neuromyotonia (muscle cramps and stiffness)
Myokymia (muscle twitching with a rippling appearance) occurring in the limbs or especially in the muscles of the face or hands
Childhood or early-adolescent disease onset (average age of onset: ~8 years)
Source: GeneReviews — "Episodic Ataxia Type 1"
Episodic ataxia can occur sporadically or in a number of hereditary or acquired disorders.
Table 2.
Disorders to Consider in the Differential Diagnosis of Episodic Ataxia Type 1
Disorder | Gene | MOI | Clinical Features | Onset | Frequency of Attacks | Attack Triggers | Treatment | Interictal Findings
EA21(OMIM 108500) | CACNA1A | AD | • Paroxysmal attacks of ataxia, vertigo, nausea lasting minutes to days; can be assoc w/dysarthria, diplopia, tinnitus, dystonia, hemiplegia, headache (migraine in ~50%)
Atrophy of cerebellar vermis on MRI
| Typically childhood or early adolescence (range: 2-32 yrs) | Range: 1-2/yr to 3-4/wk | • Stress
Exertion
Caffeine
Alcohol
Fever
Heat
Phenytoin
Source: GeneReviews — "Episodic Ataxia Type 1"
Biomarker and diagnostic research for hereditary episodic ataxia has been reported in the published literature.
System/Concern |
|---|
Evaluation |
|---|
Comment |
|---|
Neurologic | Neurologic exam | Incl initiation ( observation) of attacks by either mild exercise or vestibular stimuli (see , Triggers) Electromyogram |
Other | Consultation w/clinical geneticist /or genetic counselor | 1. , , Treatment of Manifestations Table 4. |
Treatment of Manifestations in Individuals with Episodic Ataxia Type 1 Manifestation/Concern | Treatment | Considerations/Other |
Typical attacks1 | Acetazolamide2: 125 mg orally 1x/day starting dose; in those w/good renal function, daily doses may be required: 8-30 mg/kg/day in 1-4 divided doses (max dose: 1 g/day) | Acetazolamide should not be prescribed to patients w/liver, renal, or adrenal insufficiency. Phenytoin 3.7 mg/kg/day may improve muscle stiffness motor performance.3,4 |
Seizures | Diphenylhydantoin 150-300 mg/day | Resulted in reasonable control of seizures in some Other anti-seizure meds may be required to control seizures in some.10 |
Scoliosis | Routine treatment per orthopedist | Several drugs variably improve EA1 symptoms, but with the lack of clinical trials comparing the efficacy of these drugs, no single medication has been proven to be very effective. |
Source: GeneReviews — "Episodic Ataxia Type 1"
Known triggers of attacks (see , Triggers) should be avoided; physical exertion, emotional stress, and changes in environmental temperature are the most common triggers. Marked generalized myokymia has been reported during induction of anesthesia .
Source: GeneReviews — "Episodic Ataxia Type 1"
Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for information on clinical studies for a wide range of diseases and conditions. Note: There may not be clinical trials for this disorder.
Source: GeneReviews — "Episodic Ataxia Type 1"
1 trial found
Patient case studies | 35 | 25% |
Laboratory research | 30 | 21% |
Disease patterns and progression | 16 | 11% |
Testing and diagnosis research | 7 | 5% |
Clinical study results | 7 | 5% |
Other research | 4 | 3% |
New treatment approaches | 2 | 1% |
Kim HJ (2026). [PMID: 41781521](https://pubmed.ncbi.nlm.nih.gov/41781521/). *J Neurol*. [Basic Science / Preclinical]
Iruzubieta P (2026). [PMID: 42055934](https://pubmed.ncbi.nlm.nih.gov/42055934/). *Parkinsonism Relat Disord*. [Diagnostic / Biomarker]
Onder H (2026). [PMID: 41922815](https://pubmed.ncbi.nlm.nih.gov/41922815/). *Neurol Sci*. [Other]
Carlein C (2026). [PMID: 41136741](https://pubmed.ncbi.nlm.nih.gov/41136741/). *Diabetologia*. [Basic Science / Preclinical]
Park WY (2026). [PMID: 41603258](https://pubmed.ncbi.nlm.nih.gov/41603258/). *J Cachexia Sarcopenia Muscle*. [Basic Science / Preclinical]
Carvalho B (2026). [PMID: 41951501](https://pubmed.ncbi.nlm.nih.gov/41951501/). *Parkinsonism Relat Disord*. [Diagnostic / Biomarker]
Long Z (2026). [PMID: 42067833](https://pubmed.ncbi.nlm.nih.gov/42067833/). *BMC Neurol*. [Case Report / Case Series]
Kerstens J (2026). [PMID: 41270249](https://pubmed.ncbi.nlm.nih.gov/41270249/). *Neurol Neuroimmunol Neuroinflamm*. [Epidemiology / Natural History]
Anderson EN (2026). [PMID: 41468891](https://pubmed.ncbi.nlm.nih.gov/41468891/). *Am J Hum Genet*. [Gene Therapy / Novel Therapeutics]
Servettini I (2026). [PMID: 42191098](https://pubmed.ncbi.nlm.nih.gov/42191098/). *Biochim Biophys Acta Mol Basis Dis*. [Basic Science / Preclinical]