Garth A. Nicholson

Garth A. Nicholson

PhD, MBBS, FRACP

Neurologist

58 years of Experience

Male📍 Sydney

About of Garth A. Nicholson

Garth A. Nicholson is a neurologist based in Sydney, NSW 2139. He works with people who have long-term brain and nerve conditions, and also with those who are trying to work out what is going on when symptoms don’t fit neatly into one box.


Neurology can be complex, especially when it involves muscles, nerves, or movement. Dr Nicholson looks after patients with motor neuron conditions like ALS (Lou Gehrig’s disease) and primary lateral sclerosis. He also helps people dealing with nerve problems, such as Charcot-Marie-Tooth disease and other inherited or long-term peripheral neuropathies. At times, he cares for families where symptoms point to an inherited condition, so it’s not only about treatment, but also about understanding the cause.


Many people see a neurologist because of changes in movement, balance, or sensation. Dr Nicholson commonly supports patients with movement disorders, spasticity, and problems like muscle weakness, ataxia, or trouble with coordination. He also has experience with conditions that can affect thinking and behaviour, including frontotemporal dementia.


There’s also a big genetics side to his work. Over the years, he has seen a range of rare and inherited conditions, and that helps when the story is unusual or symptoms develop slowly. When families need clarity, he tends to take a careful, practical approach and helps connect the dots between symptoms, tests, and what it might mean for the future.


Dr Nicholson brings 58 years of experience to the work. His education includes PhD and medical training from the University of Sydney, along with specialist fellowship training. He has a PhD in protein biochemistry and molecular biology (1975), a MBBS (1967), and he is a Fellow of the Royal Australasian College of Physicians (FRACP). That mix of lab and clinical training is useful, especially in conditions where nerves and muscles are affected in a specific way.


Research is part of his background as well. He has publications in the neurology space, and this helps keep his clinical thinking grounded in evidence over time. If you’re coming in for review after scans or nerve testing, or you’re still figuring out the diagnosis, he can help explain what the results mean in plain language.


Clinical trials: no specific trial details are listed, but his long career and research involvement means he understands how studies and new treatments fit into real-world care.

Education

  • PhD (Protein biochemistry / molecular biology) — University of Sydney — 1975
  • MBBS (Bachelor of Medicine, Bachelor of Surgery) — University of Sydney — 1967
  • FRACP (Fellow — Royal Australasian College of Physicians)

Services & Conditions Treated

Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig's Disease)Primary Lateral SclerosisCharcot-Marie-Tooth DiseaseHajdu-Cheney SyndromeHereditary Sensory and Autonomic Neuropathy Type 2Hereditary Sensory Neuropathy Type 1 (HSN1)AnhidrosisCHARGE SyndromeFrontotemporal DementiaMenkes DiseaseOccipital Horn SyndromeOlivopontocerebellar AtrophySpinal Muscular Atrophy (SMA)Spinal Muscular Atrophy Type 2Spinal Muscular Atrophy Type 3Spinocerebellar Ataxia Type 3Striatonigral Degeneration InfantileAlternating Hemiplegia of ChildhoodAutonomic NeuropathyCoats DiseaseColorectal CancerCongenital Fiber-Type DisproportionDementiaDrug Induced DyskinesiaFacioscapulohumeral Muscular Dystrophy (FSHD)Familial Multiple LipomatosisFarber LipogranulomatosisGaucher DiseaseHearing LossHemiplegiaLimb-Girdle Muscular DystrophyMovement DisordersMultiple Symmetric LipomatosisPeripheral NeuropathyPontocerebellar HypoplasiaPorphyriaRectal ProlapseSensorimotor PolyneuropathySpastic Paraplegia Type 2Spastic Paraplegia Type 5ASpastic Paraplegia Type 7Spinocerebellar AtaxiaTelangiectasiaTubular Aggregate MyopathyWilson DiseaseX-Linked Myotubular Myopathy

Publications

5 total
Author Correction: A CCG expansion in ABCD3 causes oculopharyngodistal myopathy in individuals of European ancestry.

Nature Communications • October 17, 2024

Andrea Cortese, Sarah Beecroft, Stefano Facchini, Riccardo Curro, Macarena Cabrera Serrano, Igor Stevanovski, Sanjog Chintalaphani, Hasindu Gamaarachchi, Ben Weisburd, Chiara Folland, Gavin Monahan, Carolin Scriba, Lein Dofash, Mridul Johari, Bianca Grosz, Melina Ellis, Liam Fearnley, Rick Tankard, Justin Read, Ashirwad Merve, Natalia Dominik, Elisa Vegezzi, Ricardo Schnekenberg, Gorka Fernandez Eulate, Marion Masingue, Diane Giovannini, Martin Delatycki, Elsdon Storey, Mac Gardner, David Amor, Garth Nicholson, Steve Vucic, Robert Henderson, Thomas Robertson, Jason Dyke, Vicki Fabian, Frank Mastaglia, Mark Davis, Marina Kennerson, Simon Hammans, Arianna Tucci, Melanie Bahlo, Catriona Mclean, Nigel Laing, Tanya Stojkovic, Henry Houlden, Michael Hanna, Ira Deveson, Paul Lockhart, Phillipa Lamont, Michael Fahey, Enrico Bugiardini, Gianina Ravenscroft

Oculopharyngodistal myopathy (OPDM) is an inherited myopathy manifesting with ptosis, dysphagia and distal weakness. Pathologically it is characterised by rimmed vacuoles and intranuclear inclusions on muscle biopsy. In recent years CGG • CCG repeat expansion in four different genes were identified in OPDM individuals in Asian populations. None of these have been found in affected individuals of non-Asian ancestry. In this study we describe the identification of CCG expansions in ABCD3, ranging from 118 to 694 repeats, in 35 affected individuals across eight unrelated OPDM families of European ancestry. ABCD3 transcript appears upregulated in fibroblasts and skeletal muscle from OPDM individuals, suggesting a potential role of over-expression of CCG repeat containing ABCD3 transcript in progressive skeletal muscle degeneration. The study provides further evidence of the role of non-coding repeat expansions in unsolved neuromuscular diseases and strengthens the association between the CGG • CCG repeat motif and a specific pattern of muscle weakness.

A deep intronic variant in MME causes autosomal recessive Charcot-Marie-Tooth neuropathy through aberrant splicing.

Journal Of The Peripheral Nervous System : JPNS • April 10, 2024

Bianca Grosz, Jevin Parmar, Melina Ellis, Samantha Bryen, Cas Simons, Andre L Reis, Igor Stevanovski, Ira Deveson, Garth Nicholson, Nigel Laing, Mathew Wallis, Gianina Ravenscroft, Kishore Kumar, Steve Vucic, Marina Kennerson

Background: Loss-of-function variants in MME (membrane metalloendopeptidase) are a known cause of recessive Charcot-Marie-Tooth Neuropathy (CMT). A deep intronic variant, MME c.1188+428A>G (NM_000902.5), was identified through whole genome sequencing (WGS) of two Australian families with recessive inheritance of axonal CMT using the seqr platform. MME c.1188+428A>G was detected in a homozygous state in Family 1, and in a compound heterozygous state with a known pathogenic MME variant (c.467del; p.Pro156Leufs*14) in Family 2. Objective: We aimed to determine the pathogenicity of the MME c.1188+428A>G variant through segregation and splicing analysis. Methods: The splicing impact of the deep intronic MME variant c.1188+428A>G was assessed using an in vitro exon-trapping assay. Results: The exon-trapping assay demonstrated that the MME c.1188+428A>G variant created a novel splice donor site resulting in the inclusion of an 83 bp pseudoexon between MME exons 12 and 13. The incorporation of the pseudoexon into MME transcript is predicted to lead to a coding frameshift and premature termination codon (PTC) in MME exon 14 (p.Ala397ProfsTer47). This PTC is likely to result in nonsense mediated decay (NMD) of MME transcript leading to a pathogenic loss-of-function. Conclusions: To our knowledge, this is the first report of a pathogenic deep intronic MME variant causing CMT. This is of significance as deep intronic variants are missed using whole exome sequencing screening methods. Individuals with CMT should be reassessed for deep intronic variants, with splicing impacts being considered in relation to the potential pathogenicity of variants.

A CCG expansion in ABCD3 causes oculopharyngodistal myopathy in individuals of European ancestry.

Nature Communications • September 29, 2023

Andrea Cortese, Sarah Beecroft, Stefano Facchini, Riccardo Curro, Macarena Cabrera Serrano, Igor Stevanovski, Sanjog Chintalaphani, Hasindu Gamaarachchi, Ben Weisburd, Chiara Folland, Gavin Monahan, Carolin Scriba, Lein Dofash, Mridul Johari, Bianca Grosz, Melina Ellis, Liam Fearnley, Rick Tankard, Justin Read, Ashirwad Merve, Natalia Dominik, Elisa Vegezzi, Ricardo Schnekenberg, Gorka Fernandez Eulate, Marion Masingue, Diane Giovannini, Martin Delatycki, Elsdon Storey, Mac Gardner, David Amor, Garth Nicholson, Steve Vucic, Robert Henderson, Thomas Robertson, Jason Dyke, Vicki Fabian, Frank Mastaglia, Mark Davis, Marina Kennerson, Simon Hammans, Arianna Tucci, Melanie Bahlo, Catriona Mclean, Nigel Laing, Tanya Stojkovic, Henry Houlden, Michael Hanna, Ira Deveson, Paul Lockhart, Phillipa Lamont, Michael Fahey, Enrico Bugiardini, Gianina Ravenscroft

Oculopharyngodistal myopathy (OPDM) is an inherited myopathy manifesting with ptosis, dysphagia and distal weakness. Pathologically it is characterised by rimmed vacuoles and intranuclear inclusions on muscle biopsy. In recent years CGG • CCG repeat expansion in four different genes were identified in OPDM individuals in Asian populations. None of these have been found in affected individuals of non-Asian ancestry. In this study we describe the identification of CCG expansions in ABCD3, ranging from 118 to 694 repeats, in 35 affected individuals across eight unrelated OPDM families of European ancestry. ABCD3 transcript appears upregulated in fibroblasts and skeletal muscle from OPDM individuals, suggesting a potential role of over-expression of CCG repeat containing ABCD3 transcript in progressive skeletal muscle degeneration. The study provides further evidence of the role of non-coding repeat expansions in unsolved neuromuscular diseases and strengthens the association between the CGG • CCG repeat motif and a specific pattern of muscle weakness.

Distribution of ubiquilin 2 and TDP-43 aggregates throughout the CNS in UBQLN2 p.T487I-linked amyotrophic lateral sclerosis and frontotemporal dementia

Brain Pathology (Zurich, Switzerland) • September 25, 2023

Laura Nementzik, Kyrah Thumbadoo, Helen Murray, David Gordon, Shu Yang, Ian Blair, Clinton Turner, Richard L Faull, Maurice Curtis, Catriona Mclean, Garth Nicholson, Molly E Swanson, Emma Scotter

Mutations in the UBQLN2 gene cause amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). The neuropathology of such UBQLN2-linked cases of ALS/FTD is characterised by aggregates of the ubiquilin 2 protein in addition to aggregates of the transactive response DNA-binding protein of 43 kDa (TDP-43). ALS and FTD without UBQLN2 mutations are also characterised by TDP-43 aggregates, that may or may not colocalise with wildtype ubiquilin 2. Despite this, the relative contributions of TDP-43 and ubiquilin 2 to disease pathogenesis remain largely under-characterised, as does their relative deposition as aggregates across the central nervous system (CNS). Here we conducted multiplex immunohistochemistry of three UBQLN2 p.T487I-linked ALS/FTD cases, three non-UBQLN2-linked (sporadic) ALS cases, and 8 non-neurodegenerative disease controls, covering 40 CNS regions. We then quantified ubiquilin 2 aggregates, TDP-43 aggregates and aggregates containing both proteins in regions of interest to determine how UBQLN2-linked and non-UBQLN2-linked proteinopathy differ. We find that ubiquilin 2 aggregates that are negative for TDP-43 are predominantly small and punctate and are abundant in the hippocampal formation, spinal cord, all tested regions of neocortex, medulla and substantia nigra in UBQLN2-linked ALS/FTD but not sporadic ALS. Curiously, the striatum harboured small punctate ubiquilin 2 aggregates in all cases examined, while large diffuse striatal ubiquilin 2 aggregates were specific to UBQLN2-linked ALS/FTD. Overall, ubiquilin 2 is mainly deposited in clinically unaffected regions throughout the CNS such that symptomology in UBQLN2-linked cases maps best to the aggregation of TDP-43.

Hippocampal aggregation signatures of pathogenic UBQLN2 in amyotrophic lateral sclerosis and frontotemporal dementia.

Brain : A Journal Of Neurology • August 02, 2023

Kyrah Thumbadoo, Birger Dieriks, Helen Murray, Molly E Swanson, Ji Yoo, Nasim Mehrabi, Clinton Turner, Michael Dragunow, Richard L Faull, Maurice Curtis, Teepu Siddique, Christopher Shaw, Kathy Newell, Lyndal Henden, Kelly Williams, Garth Nicholson, Emma Scotter

Pathogenic variants in the UBQLN2 gene cause X-linked dominant amyotrophic lateral sclerosis and/or frontotemporal dementia characterized by ubiquilin 2 aggregates in neurons of the motor cortex, hippocampus and spinal cord. However, ubiquilin 2 neuropathology is also seen in sporadic and familial amyotrophic lateral sclerosis and/or frontotemporal dementia cases not caused by UBQLN2 pathogenic variants, particularly C9orf72-linked cases. This makes the mechanistic role of mutant ubiquilin 2 protein and the value of ubiquilin 2 pathology for predicting genotype unclear. Here we examine a cohort of 44 genotypically diverse amyotrophic lateral sclerosis cases with or without frontotemporal dementia, including eight cases with UBQLN2 variants [resulting in p.S222G, p.P497H, p.P506S, p.T487I (two cases) and p.P497L (three cases)]. Using multiplexed (five-label) fluorescent immunohistochemistry, we mapped the co-localization of ubiquilin 2 with phosphorylated TDP-43, dipeptide repeat aggregates and p62 in the hippocampus of controls (n = 6), or amyotrophic lateral sclerosis with or without frontotemporal dementia in sporadic (n = 20), unknown familial (n = 3), SOD1-linked (n = 1), FUS-linked (n = 1), C9orf72-linked (n = 5) and UBQLN2-linked (n = 8) cases. We differentiate between (i) ubiquilin 2 aggregation together with phosphorylated TDP-43 or dipeptide repeat proteins; and (ii) ubiquilin 2 self-aggregation promoted by UBQLN2 pathogenic variants that cause amyotrophic lateral sclerosis and/or frontotemporal dementia. Overall, we describe a hippocampal protein aggregation signature that fully distinguishes mutant from wild-type ubiquilin 2 in amyotrophic lateral sclerosis with or without frontotemporal dementia, whereby mutant ubiquilin 2 is more prone than wild-type to aggregate independently of driving factors. This neuropathological signature can be used to assess the pathogenicity of UBQLN2 gene variants and to understand the mechanisms of UBQLN2-linked disease.

Frequently Asked Questions

What conditions does Dr Garth A. Nicholson treat?
Dr Nicholson is a neurologist with a long history of treating a wide range of conditions. He provides services for movement disorders, dementia, spinal and peripheral neuropathies, muscle disorders, and related neurological conditions, including ALS, SMA, Charcot–Marie–Tooth disease, spinocerebellar ataxias and other hereditary neuropathies.
What services does he offer?
His services cover assessment, diagnosis and ongoing care for complex neurological conditions. Diagnoses and management focus areas include motor and nerve disorders, neurodegenerative conditions and related syndromes.
How can I book an appointment?
To book an appointment, please contact the clinic where Dr Nicholson practices in Sydney. You may need a referral from your GP or another specialist, depending on your situation.
Where is he located?
Dr Nicholson practices in Sydney, NSW 2139, Australia.
How experienced is Dr Nicholson?
Dr Nicholson has about 58 years of experience as a practising neurologist and holds MBBS and FRACP qualifications along with a PhD.
What should I bring to my first appointment?
Bring any relevant medical records, current medications, and details of your symptoms and medical history. If you have prior test results or imaging, bring copies if possible.

Contact Information

Sydney, NSW 2139, Australia

Is this your profile?

Claim this profile →

Memberships

  • the Royal Australasian College of Physicians (FRACP)
  • Human Genetics Society of Australasia (HGSA)
  • Australian and New Zealand Association of Neurologists (ANZAN)