SMA is a neurodegenerative disorder that—left untreated—can result in progressive muscular atrophy, and in its most severe forms, premature death1,2

Spinal muscular atrophy (SMA) is a rare genetic disease caused by the deletion or mutation of the survival motor neuron 1 (SMN1) gene. The SMN1 gene produces survival motor neuron (SMN) protein that is critical for normal function of motor neurons.

Patients with SMA have an insufficient amount of SMN protein, which leads to permanent loss of motor neurons. Untreated, SMA Type 1 is the number one genetic cause of infant death.3-5

Diagnosis and treatment choice

Hear from experts in SMA care on the cause of SMA, how ZOLGENSMA works, and what to expect during the treatment decision conversation.

Key signs of SMA 

At birth, infants may appear normal, but can develop some of these signs as they age3,4,6:

  • Muscle weakness and hypotonia
  • Areflexia
  • Impaired head control
  • Reduced bulbar function, including impaired swallowing, feeding, and weak cry and cough
  • Tongue fasciculations
  • Paradoxical breathing, also known as “belly breathing,” and bell-shaped chest due to intercostal muscle weakness
  • Progressive respiratory failure requiring noninvasive ventilation (NIV)
  • Missed motor milestones
Infant spinal muscular atrophy patient showing a sign of SMA called floppy baby syndrome
Floppy baby syndrome

Image from Videos on File. AveXis, Inc., 2018.7

Infant with spinal muscular atrophy showing a sign of SMA called frog-leg position
Frog-leg position

Image used with permission from CureSMA.8

Infant with spinal muscular atrophy showing a sign of SMA called impaired head control
Impaired head control

Image reprinted by permission from Elsevier. From: Sumner CJ, Paushkin S, Ko CP, eds. Spinal muscular atrophy.
Amsterdam, the Netherlands:
Elsevier; 2017.9

SMA is diagnosed with genetic testing4

SMA is classically categorized by type. Clinical features and expected outcomes are based on the natural history of untreated patients.3

If SMA is suspected, a genetic test can confirm a homozygous mutation of the SMN1 gene. Further genetic testing can determine SMN2 copy number, which is an indicator for severity. Patients with SMA rely on the SMN2 backup gene for SMN protein production; however, approximately only 10% of SMN protein produced by SMN2 is functional.3,4

SMA TypeType 1Type 2Type 3
SMN15Nearly all patients with SMA, regardless of type, will have bi-allelic deletions or mutations of SMN1
SMN2 copy number5,101-32-33-4
Incidence rate11~60%~27%~12%
Age of onset120-6 months6-18 months>18 months
Maximal motor milestones achieved12Never achieve sittingSit but never walkStand and walk
Key clinical features3,4Severe hypotonia, respiratory insufficiency, poor feeding and head controlScoliosis, unable to walk independently, proximal weaknessProximal weakness, may lose ability to walk over time

The Novartis Gene Therapies Laboratory Testing Program can support in assisting genetic testing. For more information, please contact your Novartis Gene Therapies Regional Account Associate Director or call the OneGene Program® at 1-855-441-GENE (4363)

Diagnosis and Treatment

Learn more about diagnosing and treating SMA

Diagnosis and Treatment

References: 1. Talbot K, Tizzano EF. The clinical landscape for SMA in a new therapeutic era. Gene Ther. 2017;24(9):529-533. 2. Lin CW, Kalb SJ, Yeh WS. Delay in diagnosis of spinal muscular atrophy: a systematic literature review. Pediatr Neurol. 2015;53(4):293-300. 3. Kolb SJ, Kissel JT. Spinal muscular atrophy. Neurol Clin. 2015;33(4):831-846. 4. Wirth B, Karakaya M, Kye MJ, Mendoza-Ferreira N. Twenty-five years of spinal muscular atrophy research: from phenotype to genotype to therapy, and what comes next. Annu Rev Genomics Hum Genet. 2020;21:231-261. 5. Anderton RS, Mastaglia FL. Advances and challenges in developing a therapy for spinal muscular atrophy. Expert Rev Neurother. 2015;15(8):895-908. 6. Wang CH, Finkel RS, Bertini ES, et al; Participants of the International Conference on SMA Standard of Care. Consensus statement for standard of care in spinal muscular atrophy. J Child Neurol. 2007;22(8):1027-1049. 7. Data on file. AveXis, Inc. 2020. 8. Accessed February 21, 2023. 9. Oskoui M, Darras BT, De Vivo DC. Chapter 1—Spinal muscular atrophy: 125 years later and on the verge of a cure. In: Sumner CJ, Paushkin S, Ko CP, eds. Spinal Muscular Atrophy. Amsterdam, the Netherlands: Elsevier; 2017. 10. Finkel RS, McDermott MP, Kaufmann P, et al. Observational study of spinal muscular atrophy type I and implications for clinical trials. Neurology. 2014;83(9):810-817. 11. Ogino S, Wilson RB, Gold B. New insights on the evolution of the SMN1 and SMN2 region: simulation and meta-analysis for allele and haplotype frequency calculations. Eur J Hum Genet. 2004;12(12):1015-1023. 12. Farrar MA, Park SB, Vucic S, et al. Emerging therapies and challenges in spinal muscular atrophy. Ann Neurol. 2017;81(3):355-368.