title: Krabbe disease in adults: phenotypic and genotypic update from a series of 11 cases and a review.
abstract: Krabbe disease usually presents as a severe leukodystrophy in early infancy and childhood. From a series of 11 patients and 30 cases previously reported in the literature we describe the clinical, radiological, electrophysiological and genetic features of adult Krabbe disease. Patients diagnosed after the age of 16 years were included in this study. They were further divided into three groups depending on age at symptoms onset: (1) childhood onset cases (n = 7); (2) adolescence onset cases (n = 6) and adult onset cases (n = 28). Overall, 96 % of patients in the adult-onset group presented with signs of pyramidal tracts dysfunction. Spastic paraparesis or tetraparesis became prominent in all cases. A peripheral neuropathy was present in 59 % of cases and was most often demyelinating (80 %). Other clinical signs encompassed dysarthria (31 %), cerebellar ataxia (27 %), pes cavus (27 %), deep sensory signs (23 %), tongue atrophy (15 %), optic neuropathy (12 %), cognitive decline (12 %). Cerebrospinal fluid protein concentration was moderately increased in 54 % of patients. Patients in the adolescent- and childhood-onset groups had similar presentations but were more likely to display optic neuropathy (33 % and 57 %) and cerebellar ataxia (50 % and 57 %). In the adult-onset group, the disease progressed slowly over more than 10 years, but a rapid course was observed in two patients. Abnormalities of brain MRI was similar in the three groups and included high signals of cortico-spinal tracts (94 % of cases), hyper-intensities of optic radiations (89 %) and hyper-intensities or atrophy of the posterior part of the corpus callosum (60 %). No clear genotype-phenotype relationship could be demonstrated.
authors.affiliation: Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris and University Pierre&Marie Curie, Paris, France.
authors.forename: Rabab
authors.initials: R
authors.lastname: Debs
authors.forename: Roseline
authors.initials: R
authors.lastname: Froissart
authors.forename: Patrick
authors.initials: P
authors.lastname: Aubourg
authors.forename: Caroline
authors.initials: C
authors.lastname: Papeix
authors.forename: Claire
authors.initials: C
authors.lastname: Douillard
authors.forename: Bertrand
authors.initials: B
authors.lastname: Degos
authors.forename: Bertrand
authors.initials: B
authors.lastname: Fontaine
authors.forename: Bertrand
authors.initials: B
authors.lastname: Audoin
authors.forename: Arnaud
authors.initials: A
authors.lastname: Lacour
authors.forename: Gérard
authors.initials: G
authors.lastname: Said
authors.forename: Marie T
authors.initials: MT
authors.lastname: Vanier
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sedel
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D002648:Child; D005260:Female; D005838:Genotype; D006801:Humans; D007965:Leukodystrophy, Globoid Cell / Q000175:diagnosis* / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D055815:Young Adult