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ORIGINAL RESEARCH article

Front. Neurol.

Sec. Movement Disorders

Volume 16 - 2025 | doi: 10.3389/fneur.2025.1669059

Delphi study to elicit expert consensus around decision-making in the treatment of Friedreich ataxia

Provisionally accepted
Sheng-Han  KuoSheng-Han Kuo1Cuixia  TianCuixia Tian2James  McKayJames McKay3Sarah  M EnglandSarah M England3Monica  SimonMonica Simon3Marlon  GrafMarlon Graf4*Iris  P BrewerIris P Brewer4Natalie  LandNatalie Land4Jacquelyn  W ChouJacquelyn W Chou4Richard  LawsonRichard Lawson3
  • 1Columbia University Medical Center, New York, NY, United States
  • 2Cincinnati Children's Hospital Medical Center & University of Cincinnati, College of Medicine, Cincinnati, OH, United States
  • 3Biogen Inc, Cambridge, MA, United States
  • 4Precision AQ, Bethesda, MD, United States

The final, formatted version of the article will be published soon.

Introduction: Friedreich ataxia (FA) is a rare neurological disease. This study aimed to understand current FA management and treatment practices among neurologists. Methods: An online, modified Delphi study consisting of 34 United States (US)-based neurologists with varying levels of FA experience was conducted. The Delphi questionnaire consisted of likelihood, ranking, and parameter estimation questions related to FA decision-making practices. Data collection occurred in 3 sequential rounds: completion of Delphi questionnaire, webinar discussion, and re-completion of the questionnaire. Consensus was reached in Round 3 if the inter-quartile range [IQR] was ≤25 around the median group response [MED] (scaled 0-100) or if ≥75% of panelists ranked an option in the top-2. Results were analyzed for the full panel and separately for experienced FA-treaters. Results: Panelists strongly agreed overlapping symptoms with other ataxic or neurologic conditions is a key diagnostic challenge (MED=90, IQR=1.7) with misdiagnosis being the most important driver in delayed FA diagnoses (MR=1.7, 65% top-2). General neurological exams were the most frequently used tool to assess FA disease progression (MED=100, IQR=0) whereas panelists were largely unfamiliar with any of the clinical outcome assessment scales provided (MED range: 5-10, IQR range: 20-23). Experienced FA-treaters' responses were largely consistent with the full panel; however, some differences were observed. Discussion: Consensus was reached on a portion of questions regarding FA diagnosis and assessment, perhaps due to the rarity of disease and panelists' varying FA experience. To improve and standardize management of FA, it is important to establish best practices and educate potential FA treaters as new therapies emerge.

Keywords: Friedreich Ataxia, delphi, expert consensus, diagnosis, Treatment Decision-making, clinical outcomes assessment scales

Received: 18 Jul 2025; Accepted: 06 Oct 2025.

Copyright: © 2025 Kuo, Tian, McKay, England, Simon, Graf, Brewer, Land, Chou and Lawson. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Marlon Graf, marlon.graf@precisionaq.com

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