Fahr’s Disease

What Causes Fahr’s Disease?

FD is caused by abnormal changes (mutations) in one of several different genes. Most commonly, the affected gene is SLC20A2, a gene that carries instructions for making a protein vital in the transport of phosphate into brain cells. The mutation leads to elevated phosphate levels in the bloodstream, which, in turn, promotes calcium deposits inside the cells.

The disorder may be caused by mutations in other genes, including PDGFRB, although it is unclear how they cause calcification. There is no known genetic mutation in about half of PFBC cases, but scientists believe these cases are caused by mutations that haven’t yet been identified.

Fahr Syndrome

In some cases, basal ganglia calcification is the result of some other condition. These cases are referred to as secondary basal ganglia calcification or Fahr syndrome instead of Fahr’s disease. Potential causes of Fahr syndrome include:

• Thyroid problems
• Vasculitis
• Mitochondrial disorders
• Epstein-Barr virus (EBV)
• Human immunodeficiency virus (HIV)
• Cockayne syndrome
• Aicardi-Goutieres syndrome
• Lipoid proteinosis
• Radiation
• Chemotherapy
• Carbon monoxide poisoning

Is Fahr’s Disease Hereditary?

Most of the time, FD is inherited in an autosomal dominant pattern, meaning that children may develop the disorder if they inherit even one copy of the mutated gene from either of their parents. If a parent carries the disorder-causing mutation, they will have a 50 percent chance of having an affected child with each pregnancy. A person with FD usually has at least one parent who also has the disorder.

In a smaller number of cases, FD is inherited in an autosomal recessive pattern. This means that a child must inherit two copies of the gene mutation, one from each parent, to develop the disorder. People who have only one copy of the mutated gene will not develop FD but will be carriers who can pass the mutation on to their children. Two carrier parents have a 25 percent chance of having a child with FD with each pregnancy. Half of their pregnancies will produce a carrier, and a quarter of the pregnancies will produce a child with no mutated genes.

How Is Fahr’s Disease Detected?

Symptoms of FD usually begin in adulthood after the age of 40, but they can emerge at any stage of life. Early signs may vary according to the age of onset. Onset in childhood often begins with motor and mental developmental delays. Young-adult onset is commonly associated with psychiatric symptoms. Late-onset (after age 50) is more often associated with dementia and movement disorders.

Common early signs of FD include:

• Walking difficulties
• Clumsiness
• Fatigue
• Speech problems
• Swallowing difficulties
• Dementia

How Is Fahr’s Disease Diagnosed?

A doctor may suspect FD if a patient exhibits neurological symptoms and has a family history of the disorder. The diagnostic process will aim to rule out other possible causes for the symptoms and look for the characteristic signs of FD. Diagnostic steps may include:

• Physical and neurological exams
• Laboratory tests to rule out other causes, including infections, metabolic disorders, or exposure to toxins.
• Magnetic resonance imaging (MRI) or other imaging scans to detect the pattern of brain degeneration characteristic of FFI.
• Genetic testing to look for gene mutations associated with FD

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Fahr’s Disease Treated?

FD has no cure, and no treatment will halt or reverse the progression of its symptoms. Treatment options focus on managing symptoms and preventing complications. Possible treatments include:

• Anticonvulsant medications to control seizures
• Antidepressants or other medications to treat psychiatric symptoms such as anxiety, depression, or obsessive-compulsive disorder (OCD)
• Medication to treat bladder-control problems
• Regular monitoring of neurological and mental health symptoms

How Does Fahr’s Disease Progress?

In some cases, FD causes no symptoms, and the disorder is only discovered incidentally during brain-imaging scans conducted for another reason. However, in symptomatic patients, movement-related and psychiatric symptoms usually worsen over time. Severe cases can lead to significant disabilities and a shortened life expectancy.

How Is Fahr’s Disease Prevented?

There is no known way to prevent FD. However, a genetic counselor can advise people with a family history of FD about their risk if they plan to have children.

Fahr’s Disease Caregiver Tips

Many people with Fahr’s disease also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the disorders commonly associated with FD:

• Many people with FD experience an anxiety disorder or depression, especially in the early stages of the disease.
• Dementia is a common complication of FD.
• Some cases of FD have been associated with obsessive-compulsive disorder (OCD) and psychoses such as schizophrenia.

Fahr’s Disease Brain Science

The involvement of the basal ganglia in FD helps to explain the disorder’s movement-related symptoms. The basal ganglia are structures deep within the brain that primarily control motor functions, and problems with these structures are associated with movement disorders such as Parkinson’s disease.

It is less apparent how calcification in the basal ganglia produces the neuropsychiatric symptoms commonly associated with FD. However, some scientists believe that calcium deposits impair communication between the basal ganglia and other parts of the brain, especially the frontal lobes. These brain structures are vital in functions such as problem-solving, reasoning, and judgment. Thus, impaired function of the frontal lobes and other parts of the brain that regulate mood and social behavior could be responsible for FD’s psychiatric symptoms.

Fahr’s Disease Research

Title:  Cortical-Basal Ganglia Speech Networks

Stage: Recruiting

Principal Investigator: Robert M Richardson, MD, PhD

Massachusetts General Hospital

Boston, MA

In this research study, the researchers want to learn more about brain activity related to speech perception and production.

Speech production is disrupted in several neurological diseases that involve the basal ganglia, including Parkinson’s disease (PD) and dystonia. The investigators will use a novel experimental approach and combination of analytic techniques to elucidate the contribution of neural activity in cortical-basal ganglia circuits to the hierarchical control of speech production in subjects undergoing deep brain stimulation surgery.

Title: Safety and Efficacy of Droxidopa for Fatigue in Patients With Parkinsonism

Stage: Not Yet Recruiting

Principal investigator: Khashayar Dashtipour, MD, PhD

Loma Linda University Health

Loma Linda, CA

The purpose of this study is to determine the efficacy of Droxidopa for the treatment of fatigue in patients with parkinsonism by the Visual Analog Fatigue Scale (VAFS). This is a randomized, placebo-controlled, double-blind clinical trial for three months where half the subjects will receive a placebo and the other half will receive Droxidopa. Following this will be a wash-out period of 7 days, and then all subjects will receive Droxidopa for three months during the open-label phase.

Parkinsonism is a group of symptoms seen in several diseases, including Parkinson’s Disease. In parkinsonism, a patient may become stiff, have smaller and slower movements, develop a tremor (shaking of the arms or legs), have decreased facial expression, and have a softer voice.

Fatigue is a common symptom that causes suffering and stress in diseases that affect the brain. Over 50% of patients with Parkinsonism report fatigue as one of their top three symptoms that make their life more difficult. Currently, there are no evidence-based guidelines for treating fatigue in Parkinson’s Disease, and no effective medications or therapeutic modalities exist for fatigue symptoms in patients with Parkinson’s Disease.

Droxidopa (also known by the trade name NORTHERA) is a safe and well-tolerated medication that has been approved in the USA for the treatment of orthostatic dizziness or lightheadedness in patients with a clinical diagnosis of Symptomatic Neurogenic Orthostatic Hypotension associated with primary autonomic failure (Parkinson’s Disease and Multiple System Atrophy), Dopamine Beta Hydroxylase Deficiency, or Non-Diabetic Autonomic Neuropathy.

Fatigue may be due to diminished levels of norepinephrine in Parkinson’s Disease. The locus coeruleus, one of the major sources of norepinephrine, is affected during the preclinical phase of Parkinson’s Disease during stage 2 of Braak pathology staging. Norepinephrine is the final metabolite of dopamine. Therefore by adding exogenous norepinephrine, it may be possible to control some of the motor and non-motor symptoms of parkinsonism. Norepinephrine is the final metabolite of droxidopa, and it is still unclear if it passes the blood-brain barrier. This pilot study is to measure the efficacy and safety of droxidopa in Parkinsonism patients with fatigue.

Title: Complex Eye Movements in Parkinson’s Disease and Related Movement Disorders

Stage: Recruiting

Principal investigator: Hector Rieiro, PhD

Dignity Health / St. Joseph’s Hospital and Medical Center

Phoenix, AZ

Diagnosing Parkinson’s disease (PD) depends on the clinical history of the patient and the patient’s response to specific treatments such as levodopa. Unfortunately, a definitive diagnosis of PD is still limited to post-mortem evaluation of brain tissues. Furthermore, diagnosis of idiopathic PD is even more challenging because symptoms of PD overlap with symptoms of other conditions such as essential tremor (ET) or Parkinsonian syndromes (PSs) such as progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), or vascular Parkinsonism (VaP). Based on the principle that PD and PSs affect brain areas involved in eye movement control, this trial will utilize a platform that records complex eye movements and use a proprietary algorithm to characterize PSs. Preliminary data demonstrate that by monitoring oculomotor alterations, the process can assign PD-specific oculomotor patterns, which have the potential to serve as a diagnostic tool for PD.

This study will evaluate the capabilities of the process and its ability to differentiate PD from other PSs with statistical significance. This proposal aims to optimize the detection and analysis algorithms and then evaluate the process against neurological diagnoses of PD patients in a clinical study.

In Phase I, complex eye movements, including Fixation, Optokinetic Nystagmus (OKN), Guided Saccades, Microsaccades, Smooth Pursuit, and Pupillometry will be measured in 90 subjects (30 PD, 30 non-PD with other movement disorders (PSP, ET, CBD, etc.), and 30 normal defined as not having any symptoms of any neurological condition.) The patients will be classified according to clinical evaluations and clinical follow-ups performed by Dr. Holly Shill, the Lonnie and Muhammad Ali Parkinson Center Director at the Barrow Neurological Institute (Phoenix, AZ). A 3-way analysis will be performed to troubleshoot and optimize the detection and classification algorithms. At this stage, these results will only be used for the evaluation of the diagnostic capability of the tool and not to treat or diagnose the patient. The product is portable with the potential to be an accurate tool to diagnose PD. This tool will provide substantial support to neurologists by validating or complementing the clinical tests currently used to diagnose PD. Successful diagnosis of PD can open new avenues for diagnosing other neurological conditions.