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Data were compared with 16 healthy controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All but one of the ataxic and 60% of pre-ataxic individuals experienced muscle cramps at least weekly. Neuropathic pain was reported by 20% of pre-ataxic and 16.7% of ataxic mutation carriers, while the average number of autonomic symptoms in both groups was 2 and 4.7, respectively. Neuropathy severity scores were significantly higher in pre-ataxic and ataxic individuals than in\u00a0healthy controls and associated with (i) worse self-reported functional status and (ii) clinician-reported ataxia severity. The number of autonomic symptoms was associated with patient-reported impairments in daily life and quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Clinical features of peripheral and autonomic nervous system degeneration are very common in SCA3, may already be observed in pre-ataxic individuals, and independently contribute to patient-reported disease burden and clinician-rated overall ataxia severity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-025-13588-x","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T16:21:40Z","timestamp":1767802900000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Peripheral and autonomic nervous system involvement in spinocerebellar ataxia type 3: unveiling an invisible burden"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2204-308X","authenticated-orcid":false,"given":"Kristofoor E.","family":"Leeuwenberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7839-8125","authenticated-orcid":false,"given":"Nens","family":"van Alfen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4412-1616","authenticated-orcid":false,"given":"Bart P.","family":"van de Warrenburg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0823-1287","authenticated-orcid":false,"given":"Roderick P. 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N.v.A. works as an ultrasound instructor for Sonoskills and performs editorial duties for Wiley Publishing; all payment goes to their employer. B.P.v.d.W. is supported by research grants from the Dutch Scientific Organization, ZonMw, Hersenstichting, FARA, Christina Foundation, and Servier; has served on scientific advisory boards for Biogen, Biohaven, and Vico Therapeutics; and receives royalties from BSL\/Springer Nature. R.P.P.W.M.M. receives research funding from the National Ataxia Foundation, Ataxia UK, Friedreich\u2019s Ataxia Research Alliance, and Stichting Friedreich Ataxie Nederland.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The study was approved by the Medical Research Ethics Committee (MREC) Oost-Nederland. Written informed consent was obtained from all participants.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"64"}}