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SCA3 is also characterized by dysfunction of the pyramidal tract, manifesting as spasticity and hyperreflexia, which is variably associated with peripheral muscular atrophy and/or other motor-related clinical manifestations such as parkinsonism, dysarthria, nystagmus, dystonia, and external progressive ophthalmoplegia

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This is consistent with the diminished hypertrophic response of mature or aged muscle to IGF-I, where there is a reduction in the pool of activated satellite cells compared to young, growing muscle 88