title: Neurology of Fabry disease.
abstract: BACKGROUND
  Fabry disease has diverse neurological manifestations, many of which influence morbidity and quality of life.
  
  
  OBJECTIVE
  The aim of the study was to document the clinical and subclinical neurological manifestations in a cohort of Australian patients with Fabry disease, using multiple clinical tools and a multidisciplinary approach.
  
  
  METHODS
  Participants completed focused questionnaires and underwent clinical neurological examination, Neurocognitive testing using Mini Mental State Examination and Neuropsychiatry Unit Cognitive Screen, Quantitative Sensory Testing (QST), autonomic assessment using RR interval variation, intracranial magnetic resonance imaging (MRI) and audiology. In subsets of patients who had previously undergone QST and/or prospective serial quality-of-life assessments over the previous 5 years, results before and after enzyme replacement therapy were compared.
  
  
  RESULTS
  Twenty hemizygotes and two heterozygotes were recruited. The age (mean +/- standard deviation (SD)) of male participants was 40.4 +/- 11.9 years (range 20-62 years); the women were aged between 20 and 56 years. Increasing age was strongly associated with increasing neurological disability. Clinical peripheral neuropathy predominantly affected thermal sensation in all patients, with variable involvement of pinprick and light touch. QST confirmed these findings. Clinical cerebellar tests were commonly abnormal: this has not been previously reported in the absence of symptomatic cerebrovascular disease. There was hearing loss was in 90% of patients and no patient older than 44 years had normal hearing. MRI lesion prevalence increased with age. Despite neurological complications being common, formal cognitive testing was basically normal. QST thresholds for pain showed a significant change after enzyme replacement therapy.
  
  
  CONCLUSIONS
  Neurological complications in Fabry disease are common, complex and may be devastating. All patients studied had neurological involvement, with protean and diverse manifestations.
authors.affiliation: Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Low
authors.forename: K
authors.initials: K
authors.lastname: Nicholls
authors.forename: N
authors.initials: N
authors.lastname: Tubridy
authors.forename: P
authors.initials: P
authors.lastname: Hand
authors.forename: D
authors.initials: D
authors.lastname: Velakoulis
authors.forename: L
authors.initials: L
authors.lastname: Kiers
authors.forename: P
authors.initials: P
authors.lastname: Mitchell
authors.forename: G
authors.initials: G
authors.lastname: Becker
mesh_terms: D000328:Adult; D018450:Disease Progression; D000795:Fabry Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011581:Psychological Tests; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires