Document Detail


Vestibular and auditory deficits in Fabry disease and their response to enzyme replacement therapy.
MedLine Citation:
PMID:  17934877     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Progressive hearing (pHL) and vestibular (pVL) loss are frequent deficits in Fabry disease (FD). Recently, enzyme replacement therapy (ERT) with human alpha-galactosidase A has become available. Here, we investigate the association between pHL and pVL in FD and their ERT responses. Pure tone audiometry (PTA) and head impulse testing (HIT) were administered at baseline in 47 patients (25 male, 18-60 y; 22 female, 17-74 y), of whom 24 also received caloric irrigation (CI). Of the 47 patients, 38 (24 male) were tested both before and during ERT (follow- up < or = 60 months). ERT consisted of agalsidase alfa infusions. At baseline, pHL was present in 88% of males and 86% of females. Over all tested frequencies (range: 0.5-6 kHz), pHL was significantly (two-way ANOVA: p < 0.05) greater at higher age and in males,with largest deficits at high frequencies. When assessed with HIT, 80% of males and 77% of females had pVL. pVL was significantly greater at higher age and in males. Tested with CI, 21% of males and 0% of females had pVL. No associations among individual semicircular canal (SCC) deficits, as tested by HIT, and hearing was observed in individual ears. After > or = 18 months of ERT, pVL was significantly smaller than at baseline (ANOVA for HIT: p < 0.01). In contrast, pHL remained unchanged by ERT over 60 months (p > 0.05). We conclude that pHL and pVL prevalences are similar in FD. To detect pVL, HIT is more sensitive than CI. We speculate that pHL and pVL emerge from lesions within the vestibulocochlear labyrinth, because no specific patterns of vestibulo-cochlear deficits were observed, as expected if lesions were more proximal along the inferior or superior branch of the vestibulo-cochlear nerve or labyrinthine artery. Finally, ERT stabilizes auditory and even improves vestibular function.
Authors:
A Palla; S Hegemann; U Widmer; D Straumann
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article     Date:  2007-10-15
Journal Detail:
Title:  Journal of neurology     Volume:  254     ISSN:  0340-5354     ISO Abbreviation:  J. Neurol.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-25     Completed Date:  2008-02-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0423161     Medline TA:  J Neurol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1433-42     Citation Subset:  IM    
Affiliation:
Neurology Department, Zurich University Hospital, Frauenklinikstrasse 26, 8091, Zurich, Switzerland. antpalla@access.unizh.ch
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Analysis of Variance
Fabry Disease / complications,  drug therapy
Female
Follow-Up Studies
Hearing Disorders / drug therapy*,  etiology
Hearing Tests / methods
Humans
Isoenzymes / therapeutic use*
Male
Middle Aged
Sex Factors
Vestibular Diseases / drug therapy*,  etiology
alpha-Galactosidase / therapeutic use*
Chemical
Reg. No./Substance:
0/Isoenzymes; EC 3.2.1.-/agalsidase alfa; EC 3.2.1.22/alpha-Galactosidase

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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