Functional and structural nerve fiber findings in heterozygote patients with Fabry disease.
Fabry disease is an X-linked inherited lysosomal disorder with dysfunction of the lysosomal enzyme alpha-galactosidase A causing accumulation of glycolipids in multiple organs including the nervous system. Pain and somatosensory disturbances are prominent manifestations of this disease. Until recently disease manifestations in female carriers of Fabry disease have been questioned. To explore the frequency of symptoms and the functional and structural involvement of the nervous system in female patients we examined the presence of pain, manifestations of peripheral neuropathy and nerve density in skin biopsies in 19 female patients with Fabry disease and 19 sex- and age-matched controls. Diaries, quantitative sensory testing, neurophysiologic tests and skin biopsies were performed. Daily pain was present in 63% of patients, with a median VAS score of 4.0. Tactile detection threshold and pressure pain threshold were lower and cold detection thresholds increased in patients. Sensory nerve action potential amplitude and maximal sensory conduction velocity were not different, whereas there was a highly significant reduction in intraepidermal nerve fiber density. We found no correlation between pain VAS score, quantitative sensory testing and intraepidermal nerve fiber density. Our study demonstrates that careful evaluation of symptoms in female Fabry patients is important as small fiber disease manifestations are present, which in some cases is only detected by skin biopsy.
Torvin Møller
Anette
A
Department of Neurology and Danish Pain Research Center, University Hospital of Aarhus, Denmark. anette@torvin.dk
Winther Bach
Flemming
F
Feldt-Rasmussen
Ulla
U
Rasmussen
Ase
A
Hasholt
Lis
L
Lan
He
H
Sommer
Claudia
C
Kølvraa
Steen
S
Ballegaard
Martin
M
Staehelin Jensen
Troels
T
D000200:Action Potentials / Q000187:drug effects / Q000502:physiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D000795:Fabry Disease / Q000150:complications / Q000235:genetics / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009412:Nerve Fibers / Q000187:drug effects* / Q000502:physiology*; D009431:Neural Conduction / Q000187:drug effects / Q000502:physiology; D009460:Neurologic Examination / Q000379:methods; D010146:Pain / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D010147:Pain Measurement / Q000379:methods; D010812:Physical Stimulation; D011788:Quality of Life; D012684:Sensory Thresholds; D012867:Skin / Q000187:drug effects / Q000294:innervation; D013223:Statistics as Topic; D013697:Thermosensing / Q000187:drug effects / Q000502:physiology; D055815:Young Adult; D000519:alpha-Galactosidase / Q000627:therapeutic use*
D000519:alpha-Galactosidase