Abstract
BACKGROUND: Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations in the α-galactosidase A (GLA) gene, leading to an increased risk for white matter lesion (WML), stroke and cerebral microbleeds. Utilizing MRI data from the prospective observational FAMOUS study we assessed MRI characteristics of FD and treatment effects of migalastat. METHODS: 19 patients with pathogenic (PV) and 14 patients with likely benign genetic variants (LBV: p.A143T, p.D313Y, and p.S126G) underwent MRI at baseline and 24 month-follow up under migalastat treatment. WML load, using Fazekas and Scheltens scores, basilar artery diameter (BAD), and the occurrence of strokes and cerebral microbleeds were assessed. Patients were compared by variant type (PV/LBV) and presence of arterial hypertension. RESULTS: WML load was low to moderate and remained stable. Four PV patients showed progress by visual examination. WML load was similar between PV and LBV groups. Patients with arterial hypertension had a higher Scheltens score. PV patients had higher BAD. No patient showed cerebral microbleeds. One PV patient with coincident multiple sclerosis demonstrated a positive central vein sign. CONCLUSION: Our data suggest that microangiopathic lesion load remains relatively stable under migalastat. Antihypertensive therapy may be important to reduce WML in FD. Further studies are needed to assess the cerebral effect of migalastat therapy.