Non-uniform orientation of H2 molecules in a magnetic field as a critical condition for the appearance of partially negative NMR lines of o-H2 in hyperpolarization experiments using p-H2.

In hyperpolarization experiments using parahydrogen, a partially negative line (PNL) of o-H2 is occasionally spotted in the nuclear magnetic resonance (NMR) spectra. This is a manifestation of the two-spin order (TSO) of the proton spins, appearing transiently in o-H2 molecules freshly derived from p-H2. For the TSO to be observable, the o-H2 NMR signal must be split into a doublet. In the literature, the splitting is believed to originate from a slow exchange of the dissolved dihydrogen with the dihydride moiety bound to a catalyst present in the reaction mixture. Because this hypothesis may be debatable, in this work a different splitting mechanism is proposed. It employs a residual dipolar coupling (RDC) between the hydrogen protons, originating from a partial orientation of the H2 molecules by the external magnetic field. The orientation effect is due to the anisotropic magnetic polarizability of H2. In a magnetic field of 11.74 T at room temperature, the currently predicted value of the RDC is -0.0024 Hz. Even such small RDC values are sufficient for the PNL effect to be clearly visible in NMR spectra for physically reasonable levels of the TSO in the o-H2 molecules. For RDC values much smaller than the natural linewidth of o-H2, the theoretical frequency distance between the minimum and maximum of PNL proves to be practically independent of the RDC and is of the order of the linewidth. The calculated amplitudes of the PNLs are proportional to the RDC values used in the calculations.

Molecular Zeeman interactions in NMR spectra of methyl groups.

Methyl groups in organic solids generally behave as uniaxial quantum rotors. The existing nuclear magnetic resonance (NMR) theory appears to be complete, capable of describing even the finest details of the temperature-dependent spectra of such objects. However, the once reported temperature effects in the carbon spectra of the C13-labeled methyl group in a single crystal of acetylsalicylic acid have still not been explained. As the temperature decreases, in the quartet corresponding to the rapid motional averaging regime, the inner lines first begin to broaden, but then, they narrow again, so that at 6 K, a pattern similar to that at room temperature was observed. In the present work, these puzzling effects are explained quantitatively by invoking the molecular Zeeman (MZ) interaction. Like the spin-rotation (SR) interaction long known to occur in methyl groups, it engages the magnetic moments generated by their torsional motions. However, it has not been considered in NMR spectroscopy until now. This is a surprising situation because in the magnetic fields currently used in NMR spectroscopy, the MZ interaction is orders of magnitude stronger than the (magnetic field independent) SR effects.

A comment on powder averaging in wide line NMR.

Computer calculations of wide line NMR spectra of powders usually involve numerical evaluation of double integrals over two Euler angles. Practice confirms intuition-based expectations that the integration results should be independent from the choice of the crystal-fixed (or molecule-fixed) coordinate system used in the calculations. However, a closer inspection of the relevant integration formulas may make one wonder why this is so. The present paper provides a rigorous mathematical proof of the validity of these intuitive predictions, by formulating the problem in terms of surface integrals on a sphere, which has presumably no precedence in the NMR literature.

Unusual effects in variable temperature powder NMR spectra of the methyl group protons in 9,10-dimethyltriptycene-d12.

Variable temperature (1)H wide line NMR spectra of polycrystalline 9,10-dimethyltriptycene-d12 deuterated in the aromatic positions were studied. The spectra show different patterns in an unrepeatable dependence on the way of preparation of the powdered samples. Simultaneously, no anomalies were seen in the MAS and CPMAS proton-decoupled room-temperature (13)C spectra as well as in powder X-ray diffraction patterns. The effects observed in the (1)H spectra are tentatively explained in terms of a phenomenological model. For one of the examined samples it afforded a consistent interpretation of the entire series of temperature dependent spectra in terms of structural non uniformity of the solid material studied. Quantum character of the stochastic dynamics of the methyl groups in the investigated compound was confirmed, although these dynamics are close to the classical limit where the familiar random jump model applies.

Spin-lattice relaxation of the methyl group protons in solids revisited: damped quantum rotation approach.

Proton spin-lattice relaxation of the methyl group in solids had been one of the most thoroughly addressed theoretical problems in nuclear magnetic resonance (NMR) spectroscopy, considered at different levels of sophistication. For systems with substantial quantum tunneling effects, several quantum mechanical treatments were reported, although in practical applications the quantum models were always augmented with or replaced by the classical jump model. However, the latter has recently proved invalid in the description of NMR line shape effects in variable-temperature spectra of hindered methyl groups, while the competing theory of damped quantum rotation (DQR) was shown to be adequate. In this work, the spin-lattice relaxation issue for the methyl protons is readdressed using the latter theory. The main outcome is that, while the existing formulas for the relaxation rates remain unchanged, the crucial parameter entering them, the correlation time of the relevant random process, need to be reinterpreted. It proves to be the inverse of one of the two quantum-rate constants entering the DQR model, neither of which, when taken separately, can be related to the jump process. It can be identified with one describing the life-time broadening of the tunnel peaks in inelastic neutron scattering (INS) spectra of the methyl groups. Such a relationship between the relaxation and INS effects was reported from another laboratory long ago, but only for the low-temperature limit where thermal population of the excited torsional levels of the methyl group can be neglected. The whole spectrum of cases encountered in practical relaxation studies on protonated methyl groups is addressed for the first time. Preliminary experimental confirmation of this novel approach is reported, based on already published NMR data for a single crystal of methylmalonic acid. The once extensively debated issues of quenching of the coherent tunneling and of the classical limit in the dynamics of the methyl groups are readdressed and presented in a consistent manner.

The natural history of spinocerebellar ataxia type 1, 2, 3, and 6: a 2-year follow-up study.

OBJECTIVE: To obtain quantitative data on the progression of the most common spinocerebellar ataxias (SCAs) and identify factors that influence their progression, we initiated the EUROSCA natural history study, a multicentric longitudinal cohort study of 526 patients with SCA1, SCA2, SCA3, or SCA6. We report the results of the 1- and 2-year follow-up visits. METHODS: As the primary outcome measure we used the Scale for the Assessment and Rating of Ataxia (SARA, 0-40), and as a secondary measure the Inventory of Non-Ataxia Symptoms (INAS, 0-16) count. RESULTS: The annual increase of the SARA score was greatest in SCA1 (2.18 ± 0.17, mean ± SE) followed by SCA3 (1.61 ± 0.12) and SCA2 (1.40 ± 0.11). SARA progression in SCA6 was slowest and nonlinear (first year: 0.35 ± 0.34, second year: 1.44 ± 0.34). Analysis of the INAS count yielded similar results. Larger expanded repeats and earlier age at onset were associated with faster SARA progression in SCA1 and SCA2. In SCA1, repeat length of the expanded allele had a similar effect on INAS progression. In SCA3, SARA progression was influenced by the disease duration at inclusion, and INAS progression was faster in females. CONCLUSIONS: Our study gives a comprehensive quantitative account of disease progression in SCA1, SCA2, SCA3, and SCA6 and identifies factors that specifically affect disease progression.

A heuristic model of damped quantum rotation effects in nuclear magnetic resonance spectra.

The damped quantum rotation (DQR) theory describes temperature effects in NMR spectra of hindered molecular rotators composed of identical atoms arranged in regular N-gons. In the standard approach, the relevant coherent dynamics are described quantum mechanically and the stochastic, thermally activated motions classically. The DQR theory is consistent. In place of random jumps over one, two, etc., maxima of the hindering potential, here one has damping processes of certain long-lived coherences between spin-space correlated eigenstates of the rotator. The damping-rate constants outnumber the classical jump-rate constants. The jump picture is recovered when the former cluster appropriately around only as many values as the number of the latter. The DQR theory was confirmed experimentally for hindered methyl groups in solids and even in liquids above 170 K. In this paper it is shown that for three-, four-, and sixfold rotators, the Liouville space equations of NMR line shapes, derived previously with the use of the quantum mechanical reduced density matrix approach, can be be given a heuristic justification. It is based on an equation of motion for the effective spin density matrix, where the relevant spin hamiltonian contains randomly fluctuating terms. The occurrence of the latter can be rationalized in terms of fluctuations of the tunneling splittings between the torsional sublevels of the rotator, including momentary liftings of the Kramers degeneracies. The question whether such degeneracy liftings are physical or virtual is discussed. The random terms in the effective hamiltonian can be Monte Carlo modeled as piecewise constant in time, which affords the stochastic equation of motion to be solved numerically in the Hilbert spin space. For sixfold rotators, this way of calculating the spectra can be useful in the instances where the Liouville space formalism of the original DQR theory is numerically unstable.

Spin-lattice relaxation study of the methyl proton dynamics in solid 9,10-dimethyltriptycene (DMT).

Proton spin-lattice relaxation studies are performed for powder samples of 9,10-dimethyltriptycene (DMT) and its isotopomer DMT-d(12) in which all the non-methyl protons in the molecule are replaced by deuterons. The relaxation data are interpreted in terms of the conventional relaxation theory based on the random jump model in which the Pauli correlations between the relevant spin and torsional states are discarded. The Arrhenius activation energies, obtained from the relaxation data, 25.3 and 24.8 kJ mol(-1) for DMT and DMT-d(12), respectively, are very high as for the methyl groups. The validity of the jump model in the present case is considered from the perspective of Haupt theory in which the Pauli principle is explicitly invoked. To this purpose, the dynamic quantities entering the Haupt model are reinterpreted in the spirit of the damped quantum rotation (DQR) approach introduced recently for the purpose of NMR lineshape studies of hindered molecular rotators. Theoretical modelling of the relevant methyl group dynamics, based on the DQR theory, was performed. From these calculations it is inferred that direct assessments of the torsional barrier heights, based on the Arrhenius activation energies extracted from relaxation data, should be treated with caution.

Theory of damped quantum rotation in nuclear magnetic resonance spectra. III. Nuclear permutation symmetry of the line shape equation.

The damped quantum rotation (DQR) theory describes manifestations in nuclear magnetic resonance spectra of the coherent and stochastic dynamics of N-fold molecular rotors composed of indistinguishable particles. The standard jump model is only a limiting case of the DQR approach; outside this limit, the stochastic motions of such rotors have no kinematic description. In this paper, completing the previous two of this series, consequences of nuclear permutation symmetry for the properties of the DQR line shape equation are considered. The systems addressed are planar rotors, such as aromatic hydrocarbons' rings, occurring inside of molecular crystals oriented in the magnetic field. Under such conditions, oddfold rotors can have nontrivial permutation symmetries only for peculiar orientations while evenfold ones always retain their intrinsic symmetry element, which is rotation by 180 degrees about the N-fold axis; in specific orientations the latter can gain two additional symmetry elements. It is shown that the symmetry selection rules applicable to the classical rate processes in fluids, once recognized as having two diverse aspects, macroscopic and microscopic, are also rigorously valid for the DQR processes in the solid state. However, formal justification of these rules is different because the DQR equation is based on the Pauli principle, which is ignored in the jump model. For objects like the benzene ring, exploitation of these rules in simulations of spectra using the DQR equation can be of critical significance for the feasibility of the calculations. Examples of such calculations for the proton system of the benzene ring in a general orientation are provided. It is also shown that, because of the intrinsic symmetries of the evenfold rotors, many of the DQR processes, which such rotors can undergo, are unobservable in NMR spectra.

SCA Functional Index: a useful compound performance measure for spinocerebellar ataxia.

OBJECTIVE: To evaluate the usefulness of functional measures in patients with spinocerebellar ataxia (SCA). METHODS: We assessed three functional measures-8 m walking time (8MW), 9-hole peg test (9HPT), and PATA repetition rate-in 412 patients with autosomal dominant SCA (genotypes 1, 2, 3, and 6) in a multicenter trial. RESULTS: While PATA rate was normally distributed (mean/median 21.7/20.5 per 10 s), the performance times for 8MW (mean/median 10.8/7.5 s) or 9HPT (mean/median 47.2/35.0 s in dominant, 52.2/37.9 s in nondominant hand) were markedly skewed. Possible learning effects were small and likely clinically irrelevant. A composite functional index (SCAFI) was formed after appropriate transformation of subtest results. The Z-scores of each subtest correlated well with the Scale for the Assessment and Rating of Ataxia (SARA), the Unified Huntington's disease Rating Scale functional assessment, and disease duration. Correlations for SCAFI with each of these parameters were stronger (Pearson r = -0.441 to -0.869) than for each subtest alone. Furthermore, SCAFI showed a linear decline over the whole range of disease severity, while 9HPT and 8MW had floor effects with respect to SARA. Analysis of possible confounders showed no effect of genotype or study site and only minor effects of age for 8MW. CONCLUSION: The proposed functional measures and their composite SCAFI have favorable properties to assess patients with spinocerebellar ataxia.

Spinocerebellar ataxia types 1, 2, 3, and 6: disease severity and nonataxia symptoms.

OBJECTIVE: To identify factors that determine disease severity and clinical phenotype of the most common spinocerebellar ataxias (SCAs), we studied 526 patients with SCA1, SCA2, SCA3. or SCA6. METHODS: To measure the severity of ataxia we used the Scale for the Assessment and Rating of Ataxia (SARA). In addition, nonataxia symptoms were assessed with the Inventory of Non-Ataxia Symptoms (INAS). The INAS count denotes the number of nonataxia symptoms in each patient. RESULTS: An analysis of covariance with SARA score as dependent variable and repeat lengths of the expanded and normal allele, age at onset, and disease duration as independent variables led to multivariate models that explained 60.4% of the SARA score variance in SCA1, 45.4% in SCA2, 46.8% in SCA3, and 33.7% in SCA6. In SCA1, SCA2, and SCA3, SARA was mainly determined by repeat length of the expanded allele, age at onset, and disease duration. The only factors determining the SARA score in SCA6 were age at onset and disease duration. The INAS count was 5.0 +/- 2.3 in SCA1, 4.6 +/- 2.2 in SCA2, 5.2 +/- 2.5 in SCA3, and 2.0 +/- 1.7 in SCA6. In SCA1, SCA2, and SCA3, SARA score and disease duration were the strongest predictors of the INAS count. In SCA6, only age at onset and disease duration had an effect on the INAS count. CONCLUSIONS: Our study suggests that spinocerebellar ataxia (SCA) 1, SCA2, and SCA3 share a number of common biologic properties, whereas SCA6 is distinct in that its phenotype is more determined by age than by disease-related factors.

Theory of damped quantum rotation in nuclear magnetic resonance spectra. II. Numerical simulations for the benzene rotor.

In Part I of this series of papers, the damped quantum rotation (DQR) theory, formulated originally for hindered threefold molecular rotors in solids, was generalized to the N-fold case. The stochastic dynamics of such objects, evidenced in NMR line shapes, was shown to be more complicated than in the standard model of classical jumps between the wells of the N-fold torsional potential. Actually, it comprises certain quantum rate (i.e., coherence-damping) processes subject to the requirements of the Pauli principle. The jump picture is recovered only when the quantum rates fit specific patterns. In this work, one of the ways of approaching such a classical limit is identified for the benzene rotor. This is inferred from a quantum mechanical model whose validity was earlier confirmed for a methyl group. Based on that model, theoretical calculations for the benzene ring dynamics in a clathrate crystal, 1-(9-anthryloxy)anthraquinone/benzene-d6, confronted with the pertinent literature data, point to possible deviations from the classical limit. However, the predicted DQR effects are too small to be observed in solid echo 2H NMR spectra of the C6D6 isotopomer. The chances of detecting the effects are improved when Carr-Purcell echo 1H spectra of a single crystal of the isotopomer including C6H6 as a guest are considered. The substantial differences in the sensitivity to the DQR effects of the spectra of protonated and deuterated benzene are concerned with different magnitudes of the intramolecular dipolar spin couplings. The dynamic isotope effect (C6D6 vs C6H6), which is small in this case, is only of secondary importance. Legitimacy of the use of the jump model in 2H NMR line shape studies of benzene-d6 is fully confirmed by the present considerations. However, the physical significance of the dynamic parameters extracted from such studies is shown from a new perspective.

J(F,H), J(C,H) and J(H,H) couplings involving the individual methyl group protons in 1,2,3,4-tetrachloro-5,6,7,8-tetrafluoro-9-methyltriptycene. Evidence of blue-shifting hydrogen bond.

1,2,3,4-tetrachloro-5,6,7,8-tetrafluoro-9-methyltriptycene was studied in NMR spectra at low temperatures where the methyl group dynamics is frozen. Values of 5J(19F,1H), 1J(13C,1H), and 2J(1H,1H) for the individual methyl protons were measured. They are in a fair agreement with the corresponding theoretical values calculated at a density functional theory (DFT) level. The 5J(19F,1H) couplings involve the peri-F nucleus and occur via the 'through space' mechanism. Both the natural bond orbital analysis (at a HF level) and the observed pattern of 1J(13C,1H) coupling values corroborate occurrence in this molecule of intramolecular, blue-shifting hydrogen bonds engaging the methyl hydrogens. The 'through space' 5J(19F,1H) couplings may indicate the routes of electron density transfers that escape detection by the natural bond analysis. A consideration of these effects can enrich the chemical intuition involving this specific sort of H-bonds.

A novel inhibitor of the STAT3 pathway induces apoptosis in malignant glioma cells both in vitro and in vivo.

Signal transducer and activator of transcription-3 (STAT3) is constitutively activated in a variety of cancer types, including malignant gliomas. STAT3 is activated by phosphorylation of a tyrosine residue, after which it dimerizes and translocates into the nucleus. There it regulates the expression of several genes responsible for proliferation and survival at the transcriptional level. A selective inhibitor of STAT3 phosphorylation, AG490, has been shown to inhibit growth and induce apoptosis in some cancer cell types. However, although AG490 routinely shows in vitro anticancer activity, it has not consistently demonstrated an in vivo anticancer effect in animal models. Here, we have tested WP1066, a novel inhibitor structurally related to AG490 but significantly more potent and active, against human malignant glioma U87-MG and U373-MG cells in vitro and in vivo. IC(50) values for WP1066 were 5.6 muM in U87-MG cells and 3.7 muM in U373-MG cells, which represents 18-fold and eightfold increases in potency, respectively, over that of AG490. WP1066 activated Bax, suppressed the expression of c-myc, Bcl-X(L) and Mcl-1, and induced apoptosis. Systemic intraperitoneal administration of WP1066 in mice significantly (P<0.001) inhibited the growth of subcutaneous malignant glioma xenografts during the 30-day follow-up period. Immunohistochemical analysis of the excised tumors revealed that phosphorylated STAT3 levels in the WP1066 treatment group remained inhibited at 3 weeks after the final WP1066 injection, whereas tumors from the control group expressed high levels of phosphorylated STAT3. We conclude that WP1066 holds promise as a therapeutic agent against malignant gliomas.

Scale for the assessment and rating of ataxia: development of a new clinical scale.

OBJECTIVE: To develop a reliable and valid clinical scale measuring the severity of ataxia. METHODS: The authors devised the Scale for the Assessment and Rating of Ataxia (SARA) and tested it in two trials of 167 and 119 patients with spinocerebellar ataxia. RESULTS: The mean time to administer SARA in patients was 14.2 +/- 7.5 minutes (range 5 to 40). Interrater reliability was high, with an intraclass coefficient (ICC) of 0.98. Test-retest reliability was high with an ICC of 0.90. Internal consistency was high as indicated by Cronbach's alpha of 0.94. Factorial analysis revealed that the rating results were determined by a single factor. SARA ratings showed a linear relation to global assessments using a visual analogue scale, suggesting linearity of the scale (p < 0.0001, r(2) = 0.98). SARA score increased with the disease stage (p < 0.001) and was closely correlated with the Barthel Index (r = -0.80, p < 0.001) and part IV (functional assessment) of the Unified Huntington's Disease Rating Scale (UHDRS-IV) (r = -0.89, p < 0.0001), whereas it had only a weak correlation with disease duration (r = 0.34, p < 0.0002). CONCLUSIONS: The Scale for the Assessment and Rating of Ataxia is a reliable and valid measure of ataxia, making it an appropriate primary outcome measure for clinical trials.

Theory of damped quantum rotation in NMR spectra. I. Fundamental aspects.

The damped quantum rotation (DQR) theory, formulated originally for methyl-like atomic groupings, is now extended to hindered (N>3)-fold molecular rotors, such as the cyclopentadienyl, benzene, and cycloheptatrienyl rings in solid phase environments. It heightens the significance of the Pauli principle in shaping up the stochastic dynamics of such objects, reflected in NMR line shapes. The corresponding NMR line-shape equation is derived; its stochastic part is shown for the first time to have the double commutator form for any values of the quantum-mechanical (coherence-damping) rate constants entering it. Constraints on the relative magnitudes of such constants are determined under which the DQR line-shape equation is converted into the phenomenological Alexander-Binsch equation describing classical jumps of the rotor. When all the quantum rate constants happen to be equal, the phenomenological model of equal jump rates between any two of the N (equivalent) orientations of the rotor is reproduced. On the other hand, the seemingly most plausible (for N>3) nearest-neighbor hopping model does not have any peculiar grounds in the DQR approach. For the special instances of stochastic molecular motions addressed in this work, the extended DQR formalism affords a quantification of the "degree of classicality" represented by a complete set of the relevant quantum rate constants. In view of our earlier experimental findings for the methyl rotors, the very occurrence of the nonclassical DQR effects seems unquestionable even for the objects of the size of benzene. The question of under what circumstances such effects can be big enough to be detected experimentally will be addressed in Part II of this work.

Carr-Purcell echo spectra in the studies of lineshape effects. Nonclassical hindered rotation of methyl groups in 1,2,3,4-tetrachloro-9,10-dimethyltriptycene.

In the standard NMR spectra, the lineshape patterns produced by a molecular rate process are often poorly structured. When alternative theoretical models of such a process are to be compared, even quantitative lineshape fits may then give inconclusive results. A detailed description is presented of an approach involving fits of the competing models to series of Carr-Purcell echo spectra. Its high discriminative power has already been exploited in a number of cases of practical significance. An explanation is given why it can be superior to methods based on the standard spectra. Its applicability in practice is now illustrated on example of the methyl proton spectra in 1,2,3,4-tetrachloro-9,10-dimethyltriptycene TCDMT. It is shown that, in the echo spectra, the recently discovered effect of nonclassical stochastic reorientation of the methyl group can be identified clearly while it is practically nondiscernible in the standard spectra of TCDMT. This is the first detection of the effect at temperatures above 200 K. It is also shown that in computer-assisted interpretation of exchange-broadened echo spectra, the usual description of the stimulating radiofrequency pulses in terms of rotation operators ought to be replaced by a more realistic pulse model.

NMR lineshape equations for hindered methyl group: a comparison of the semi-classical and quantum mechanical models.

The semiclassical and quantum mechanical NMR lineshape equations for a hindered methyl group are compared. In both the approaches, the stochastic dynamics can be interpreted in terms of a progressive symmetrization of the spin density matrix. However, the respective ways of achieving the same limiting symmetry can be remarkably different. From numerical lineshape simulations it is inferred that in the regime of intermediate exchange, where the conventional theory predicts occurrence of a single Lorentzian, the actual spectrum can have nontrivial features. This observation may open new perspectives in the search for nonclassical effects in the stochastic behavior of methyl groups in liquid-phase NMR.

Vertebral body infarction indicating midthoracic spinal stroke.

STUDY DESIGN: Case report. OBJECTIVE: To illustrate the significance of vertebral body infarction as the only confirmatory sign of spinal cord ischemic stroke. SETTING: Department of Neurology, St. Josef-Hospital, Bochum, Germany. CASE DESCRIPTION: A 65-year-old man presented with clinical features suggesting spontaneous spinal cord infarction in the territory of the left sulcocommissural artery at the level of Th 8. Sequential magnetic resonance imaging (MRI) investigations failed to demonstrate infarction of the spinal cord but T2-weighted images revealed bone marrow hyperintensities of vertebra Th 9 and 10 in their left and dorsal parts consistent with vertebral body infarction. CONCLUSION: In clinically presumed spontaneous spinal cord infarction and unremarkable signaling of the spinal cord during sequential MRI investigations vertebral body infarction may serve as the only confirmatory sign of spinal cord ischemic stroke.

Double-blind crossover trial of trimethoprim-sulfamethoxazole in spinocerebellar ataxia type 3/Machado-Joseph disease.

OBJECTIVE: To evaluate the efficiency of a combination of trimethoprim and sulfamethoxazole in patients with spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD). DESIGN: Placebo-controlled, double-blind crossover trial in 22 patients with genetically confirmed SCA3/MJD. Study phases of 6 months were separated by a washout period of 4 weeks. Dosages were a combination of trimethoprim, 160 mg, and sulfamethoxazole, 800 mg, twice daily for 2 weeks, followed by a combination of trimethoprim, 80 mg, and sulfamethoxazole, 400 mg, twice daily for 5.5 months. SETTING: Outpatient department of the Neurological Clinic, Ruhr-University, Bochum, Germany. MAIN OUTCOME MEASURES: Ataxia ranking scale, self-assessment score, static posturography, and results of motor performance testing. Effects on the visual system were studied using the achromatic Vision Contrast Test System and the Farnsworth-Munsell 100-hue test for color discrimination. Physical and mental health were documented using the Medical Outcomes Study 36-Item Short-Form Health Survey. Subgroup analyses assessed the influence of age, sex, age at onset, duration of the disease, phenotype, and CAG repeat length on test performance. RESULTS: Twenty of 22 patients completed the study. Dropouts were due to a rash (placebo phase) and an attempted suicide in a family conflict. Trimethoprim-sulfamethoxazole therapy had no significant effect in SCA3/MJD patients in the short-term analysis (2 weeks) or in the long-term interval (6 months). CONCLUSIONS: In contrast to previous reports that studied smaller groups of patients, treatment with trimethoprim-sulfamethoxazole did not improve the diverse and complex movement disorders caused by SCA3/MJD. Trimethoprim-sulfamethoxazole had no effect on the visual system and cannot be recommended as a continuous treatment for SCA3/MJD patients.