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Peultier-Celli L, Jaussaud R, Kaminsky P, Deibener-Kaminsky J, Feillet F, Perrin P. Balance control impairments in Fabry disease. Front Neurol 2022; 13:856946. [PMID: 36247762 PMCID: PMC9564708 DOI: 10.3389/fneur.2022.856946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background Fabry disease (FD) is a rare inherited lysosomal storage disorder caused by the deficiency of the enzyme alpha-galactosidase A. This deficiency leads to an accumulation of glycosphingolipids leading to progressive and multisystemic disease, including renal, cardiac, and neurological damages. FD may also have neuro-otological and visual impairments, which can generate postural control alterations, inner ear, and vision being involved in this function. This study aimed to evaluate the impact of FD on postural control. Methods In total, fourteen adult patients (8 men/6 women, mean age = 37.6 ± 11.4 years) and two children (mean age = 11 years) with FD and 19 healthy adults (12 men/7 women, mean age = 36.5 ± 16.9 years) and two healthy children (mean age = 10.5 years) took part in this study. Postural control was evaluated by a sensory organization test combining three visual situations (eyes open, eyes closed, and sway referenced visual surround motion) with two platform situations (stable platform and sway referenced platform motion), aiming to calculate a composite equilibrium score (CES), a high score being representative of good postural control. Somatosensory (RSOM), visual (RVIS), and vestibular (RVEST) contributions to postural control were calculated, a low score reflecting a poor use of the indicated sensory input. Results The CES was lower in adult patients with FD compared with the healthy subjects (p < 0.001). RVIS (p = 0.001) and RVEST (p = 0.003) were lower in patients with FD compared with the control group, whereas no difference in RSOM was observed. Conclusion Inner ear and visual pathologies associated with the central nervous system impairments are factors of postural control impairments. Physical activities, which can also be rehabilitative, by maintaining or increasing the weight of proprioception, may help diminish dependency on altered sensorial inputs.
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Affiliation(s)
- Laetitia Peultier-Celli
- EA 3450 DevAH - Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France
- Laboratory for the Analysis of Posture, Equilibrium and Motor Function (LAPEM), University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Roland Jaussaud
- EA 3450 DevAH - Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France
- Department of Internal Medicine and Clinical Immunology, Vandoeuvre-lès-Nancy, France
| | - Pierre Kaminsky
- EA 3450 DevAH - Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France
- Department of Internal Medicine and Clinical Immunology, Vandoeuvre-lès-Nancy, France
| | | | - François Feillet
- Reference Centre for Inborn Errors of Metabolism, Children Hospital, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Philippe Perrin
- EA 3450 DevAH - Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, Vandoeuvre-lès-Nancy, France
- Laboratory for the Analysis of Posture, Equilibrium and Motor Function (LAPEM), University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- Department of Pediatric Oto-Rhino-Laryngology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- *Correspondence: Philippe Perrin
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Eyermann C, Raguin T, Rohmer D, Noel E, Charpiot A. Cochleovestibular manifestations in Fabry disease: Importance of screening and systematic ENT evaluation. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:273-279. [PMID: 31072727 DOI: 10.1016/j.anorl.2019.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Fabry disease (FD) is an X-linked inherited lysosomal storage disease. It is a multisystem pathology that can include ENT disorders. The aim of the present study was to investigate the cochleovestibular manifestations of FD, in order to show the importance of screening and systematic ENT evaluation. MATERIAL AND METHODS A single-center retrospective study included 14 male and 23 female FD patients. Hearing impairment was defined as hearing loss greater than the 90th percentile for at least one frequency. Vestibular impairment was defined by lateral semicircular canal dysfunction. Age, ongoing enzyme replacement therapy (ERT) and organic (renal, cardiac and cerebrovascular) complications were used as severity markers. RESULTS Hearing impairment was found in 62.6% of cases, mostly at high frequencies, and was associated with age, ERT, and cardiac and cerebrovascular disorder. It affected 46.7% of asymptomatic adult patients. Vestibular impairment was found in 56% of cases, associated with age; it affected two-thirds of ERT patients, more than 60% of patients with organic complications, and 50% of asymptomatic adult patients. CONCLUSIONS More than half of patients had ENT involvement. All FD patients should undergo early ENT screening for diagnostic, prognostic and therapeutic purposes. Systematic complete ENT follow-up with auditory and vestibular evaluation should be performed regularly, even for heterozygous women.
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Affiliation(s)
- C Eyermann
- Service d'ORL et de chirurgie cervico-faciale, CHU de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67000 Strasbourg, France.
| | - T Raguin
- Service d'ORL et de chirurgie cervico-faciale, CHU de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67000 Strasbourg, France
| | - D Rohmer
- Service d'ORL et de chirurgie cervico-faciale, CHU de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67000 Strasbourg, France
| | - E Noel
- Service de médecine interne, diabète et maladies métaboliques, CHU de Strasbourg, hôpital Civil, 1, place de l'hôpital, 67000 Strasbourg, France
| | - A Charpiot
- Service d'ORL et de chirurgie cervico-faciale, CHU de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67000 Strasbourg, France
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Carmona S, Weinschelbaum R, Pardal A, Marchesoni C, Zuberbuhler P, Acosta P, Cáceres G, Kisinovsky I, Bayón L, Reisin R. Neuro-Otological and Peripheral Nerve Involvement in Fabry Disease. Audiol Res 2017; 7:176. [PMID: 28794847 PMCID: PMC5534773 DOI: 10.4081/audiores.2017.176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 12/17/2022] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disease, with multisystemic glycosphingolipids deposits. Neuro-otological involvement leading to hearing loss and vestibular dysfunctions has been described, but there is limited information about the frequency, site of lesion, or the relationship with peripheral neuropathy. The aim was to evaluate the presence of auditory and vestibular symptoms, and assess neurophysiological involvement of the VIII cranial nerve, correlating these findings with clinical and neurophysiological features of peripheral neuropathy. We studied 36 patients with FD with a complete neurological and neuro-otological evaluation including nerve conduction studies, quantitative sensory testing (to evaluate small fiber by warm and cold threshold detection and cold and heat pain), vestibular evoked myogenic potentials, videonistagmography, audiometry and brainstem auditory evoked potentials. Neuro-otologic symptoms included hearing loss (22.2%), vertigo (27.8%) or both (25%). An involvement of either cochlear or vestibular function was identified in most patients (75%). In 70% of our patients the involvement of both cochlear and vestibular function could not be explained by a neural or vascular mechanism. Small fiber neuropathy was identified in 77.7%. There were no significant associations between neuro-otological and QST abnormalities. Neuro-otologic involvement is frequent and most likely under-recognized in patients with FD. It lacks a specific neural or vascular pattern, suggesting multi-systemic, end organ damage. Small fiber neuropathy is an earlier manifestation of FD, but there is no correlation between the development of neuropathy and neuro-otological abnormalities.
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Affiliation(s)
- Sergio Carmona
- Department of Neuro-otology INEBA, British Hospital, Buenos Aires, Argentina
| | | | - Ana Pardal
- Department of Neurology, British Hospital, Buenos Aires, Argentina
| | | | - Paz Zuberbuhler
- Department of Neurology, British Hospital, Buenos Aires, Argentina
| | - Patricia Acosta
- Department of Neurology, British Hospital, Buenos Aires, Argentina
| | | | | | - Luciana Bayón
- Department of Neuro-otology INEBA, British Hospital, Buenos Aires, Argentina
| | - Ricardo Reisin
- Department of Neurology, British Hospital, Buenos Aires, Argentina
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Verrecchia E, Zampetti A, Antuzzi D, Ricci R, Ferri L, Morrone A, Feliciani C, Dagna L, Manna R. The impact of fever/hyperthermia in the diagnosis of Fabry: A retrospective analysis. Eur J Intern Med 2016; 32:26-30. [PMID: 27083555 DOI: 10.1016/j.ejim.2016.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/09/2016] [Accepted: 03/18/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Fabry disease (FD) is an X-linked lysosomal storage disorder caused by a deficiency of alpha-galactosidase A enzyme, which leads to the accumulation of its substrate, the globotriaosylceramide or Gb3, in many organs and tissues. Main clinical manifestations of FD are neuropathic pain, angiokeratomas, proteinuria and renal failure, left ventricular hypertrophy and stroke. Fever is also a possible symptom at the onset of the disease during childhood and adolescence, but it is frequently misdiagnosed, causing a delay in FD diagnosis. METHODS We retrospectively analysed the medical records in our series of 58 Fabry patients, focusing on the proportion of patients who exhibited fever as the main symptom at the onset of FD in order to evaluate the diagnostic delay in these patients. FINDINGS In our series, we found a significant proportion of patients with a history of fevers at the beginning of their medical history (20.7%; 12/58). 83% of patients with fever also exhibited acroparesthesias (10/12). Inflammatory markers were elevated in few of those cases (2/12). The mean diagnostic delay was 15.6±SD 12.8years. INTERPRETATION Fever emerged to be common as part of the FD clinical spectrum and it significantly contributed to the diagnostic delay encountered with this rare disease. Furthermore, our retrospective analysis indicated that FD patients commonly exhibit episodes of fever in association with other symptoms suggestive of FD (such as episodic pain crisis, acroparesthesias, hypo/anhydrosis, heat intolerance, fatigue and gastrointestinal distress). A careful analysis of the medical history in patients suffering fever could lead to an early and correct FD diagnosis. We believe that fever/hyperthermia, acroparesthesias and angiokeratoma should be considered for inclusion in the algorithm for Intermittent Fever of Unknown Origin (FUO) in order to improve the recognition of FD.
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Affiliation(s)
- Elena Verrecchia
- Periodic Fever Research Centre, A. Gemelli Policlinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Zampetti
- Department of Dermatology Saint Mary's Hospital, Imperial College NHS Trust, London, UK
| | - Daniela Antuzzi
- Department of Paediatric Sciences, A. Gemelli Policlinic, Rome, Italy
| | - Roberta Ricci
- Department of Paediatric Sciences, A. Gemelli Policlinic, Rome, Italy
| | - Lorenzo Ferri
- Laboratory for Molecular and Cell Biology of Neurologic and Metabolic Disorders, Paediatric Neurology Unit and Laboratories, Meyer Children's Hospital, Florence, Italy; Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Amelia Morrone
- Laboratory for Molecular and Cell Biology of Neurologic and Metabolic Disorders, Paediatric Neurology Unit and Laboratories, Meyer Children's Hospital, Florence, Italy; Department of NEUROFARBA, University of Florence, Florence, Italy
| | | | - Lorenzo Dagna
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaele Manna
- Periodic Fever Research Centre, A. Gemelli Policlinic, Catholic University of the Sacred Heart, Rome, Italy.
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Pichon M, Lidove O, Roudaire ML, Barry B, Herman P, Gobert D, Pasqualoni E, Compain C, Chauveheid MP, Papo T. [Auditory and vestibular findings in Fabry disease: a study of 25 patients]. Rev Med Interne 2012; 33:364-9. [PMID: 22365473 DOI: 10.1016/j.revmed.2012.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 01/05/2012] [Accepted: 01/21/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE Fabry disease (FD, OMIM 301500) is an X-linked lysosomal storage disorder due to deficient activity of the enzyme alpha-galactosidase A. Males and females exhibit severe organ involvement. The high incidence of otological symptoms was recently reported. PATIENTS AND METHODS Monocentric and retrospective study of twenty-five patients with FD (13 families; seven males and 18 females). The patients underwent audiological assessment before initiation and during enzyme replacement therapy. We also analysed neurologic heart and kidney status. RESULTS Twenty patients (80%; 13 females and seven males) complained of otologic symptoms. Audiological evaluation showed a sensorineural hearing loss in 17 patients, bilateral in 16 out of them. Vestibular examination showed a functional impairment in two patients (one female, one male). Correlations were found between hearing loss and either kidney disease (73,3%), neurological complications (100%) and cardiomyopathy (80%). Fourteen patients (56%; seven females, seven males) received enzyme replacement therapy. Improvement or stabilization of the audiological evaluation was reported in seven patients, whereas worsening was observed in three patients. CONCLUSION This study confirms the high frequency of audiological involvements in females and males with FD. Our analysis suggests that the frequency of hearing loss is increased in the presence of renal or neurologic involvement or cardiomyopathy. There is no clinically significant efficacy of enzyme replacement therapy on hearing function. Although the pathophysiology remains unknown, a vascular mechanism responsible of the inner ear involvement seems to be privileged.
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Affiliation(s)
- M Pichon
- Service de médecine interne, hôpital Bichat Claude Bernard, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
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