The aim of this study was to determine the prevalence and relative importance of symptoms experienced by children and adults with Friedreich's ataxia (FA) and to identify factors associated with a higher burden of disease. The authors conducted qualitative interviews with individuals with FA and caregivers of pediatric individuals with FA to identify potential symptoms of importance to those living with FA. They subsequently performed a cross-sectional study to assess which symptoms have the highest prevalence and importance in FA and to determine which factors are associated with a higher burden of disease. Thirty-nine participants provided 2,527 quotes regarding the symptomatic burden of FA. Two-hundred and two individuals (153 with FA and 49 caregivers) participated in a subsequent cross-sectional study. Individuals with FA and caregivers identified impaired coordination, limitations with mobility and walking, inability to do activities, fatigue, and lower extremity weakness as the most prevalent and life altering symptomatic themes in FA. Muscle stiffness and functional staging for ataxia were associated with the prevalence of symptomatic themes in FA. In addition, the length of the smaller GAA expansion and the mean length of both GAA expansions were strongly associated with the onset of symptoms in FA. There are a wide variety of symptoms that affect the lives of individuals with FA. These symptoms, many underrecognized, have different levels of importance and occur at different rates in the FA population. The most common and life altering of these symptoms represent potential targets for future therapeutic interventions.

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