Clinical Course in a Patient With Spinal Muscular Atrophy Type 0 Treated With Nusinersen and Onasemnogene Abeparvovec

J Child Neurol. 2020 Oct;35(11):717-723. doi: 10.1177/0883073820928784. Epub 2020 Jun 9.


Spinal muscular atrophy type 0 is the most severe phenotype of the disease, with patients presenting with contractures, weakness, and respiratory failure at birth, and is typically fatal within weeks. We describe the case of a patient with spinal muscular atrophy type 0 who was treated with both nusinersen and onasemnogene abeparvovec. She has made modest motor improvements since treatment initiation with a 30-point improvement in CHOP-INTEND score, and continues to make motor gains at age 13 months without regression of function, although she remains profoundly weak. Although she has had motor improvements, she has also had continued systemic complications from her spinal muscular atrophy, including chronic respiratory failure, dysphagia, congenital heart malformation, digit necrosis, and diffuse macular rash. This case highlights the challenges in treating those with more severe disease phenotypes and raises questions of how some systemic complications may respond to current SMN replacement therapies.

Keywords: ethics; infant; neuropathy; outcome; treatment.

Publication types

  • Case Reports

MeSH terms

  • Biological Products / therapeutic use*
  • Female
  • Heart Diseases / etiology
  • Heart Diseases / pathology
  • Humans
  • Infant, Newborn
  • Nervous System Diseases / etiology
  • Nervous System Diseases / pathology
  • Nutritional Support
  • Oligonucleotides / therapeutic use*
  • Osteomyelitis / etiology
  • Osteomyelitis / pathology
  • Recombinant Fusion Proteins / therapeutic use*
  • Respiration Disorders / etiology
  • Respiration Disorders / pathology
  • Skin Diseases / etiology
  • Skin Diseases / pathology
  • Spinal Muscular Atrophies of Childhood / complications
  • Spinal Muscular Atrophies of Childhood / drug therapy*
  • Spinal Muscular Atrophies of Childhood / pathology
  • Treatment Outcome


  • Biological Products
  • Oligonucleotides
  • Recombinant Fusion Proteins
  • Zolgensma
  • nusinersen