Krabbe Disease: Facts and Information

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Alternate Names for Krabbe Disease: Beta Galactocerebrosidase (GALC) Deficiency, Galactosylceramide Deficiency, Galactosylceramide Lipidosis, Globoid Cell Leukodystrophy (GLD), Krabbe Leukodystrophy, Sphingolipidoses, Krabbe type.

The U.S. Social Security Administration (SSA) has included Krabbe Disease (KD) - Infantile as a Compassionate Allowance to expedite a disability claim.

Krabbe disease is a lysosomal storage disease caused by a deficiency of galactocerebrosidase (GALC), an essential enzyme for myelin metabolism. It is one of a group of genetic disorders called leukodystrophies. These disorders impair the growth or development of the myelin sheath, the fatty covering that acts as an insulator around nerve fibers, and cause severe degeneration of mental and motor skills. Myelin, which lends its color to the "white matter" of the brain, is a complex substance composed of at least ten enzymes. Each of the leukodystrophies affects one (and only one) of these substances.

Infantile Form:

This is the most common type; onset is almost always before six months of age and even during the first week of life. Initial symptoms include restlessness, intermittent fever, irritability, and progressive stiffness (irritable-hypertonic presentation). Symptoms may develop acutely. Fever without infection is common. Convulsion may be part of the symptoms. There are also increased muscle tone and pyramidal signs. Deep tendon reflexes are often absent or weak due to peripheral neuropathy.

The second phase is characterized by a rapid deterioration in motor function, with chronic opisthotonos and myoclonic jerking, accompanied by hyperpyrexia, hypersalivation, and hypersecretion from the lungs. Rapid and severe motor and mental deterioration follow. A high CSF protein is found in all cases, and nerve conduction velocities are considerably reduced.

A final "burnt-out" stage occurs eventually. The infant becomes decerebrate and has no contact with the surroundings. The baby usually dies within the first one or two years of life, most commonly due to infection and bulbar palsy.

A fetus can be screened for Krabbe disease before birth.

Using a needle, the doctor can withdraw amniotic fluid surrounding the fetus, and then the cells in this fluid can be examined in the lab. This requires obtaining fetal cells by chorionic villus sampling or culturing amniotic fluid cells obtained by amniocentesis. After birth, a physical exam of the child, evaluation of signs and symptoms, and diagnostic testing including blood, skin (biopsy) samples, lumbar puncture (spinal tap), MRI and CT scans, nerve conduction studies, eye exam, genetic testing may be done to confirm the diagnosis.

There is no specific, proven treatment for advanced, symptomatic Krabbe disease.

Treatment at this stage is designed primarily to ease symptoms. For example, anticonvulsant medications may be used to manage the seizures associated with this disease. Other drugs may reduce the risk of vomiting. Some research indicates possible benefits associated with using bone marrow transplantation or cord blood transfusion as treatments for Krabbe disease. For pre-symptomatic infants and older individuals with mild symptoms, hematopoietic stem cell transplantation (HSCT) with cord blood is beneficial over symptomatic treatment only.

Infantile Krabbe disease is generally fatal before age 2. Prognosis may be significantly better for children who receive umbilical cord blood stem cells before disease onset or early bone marrow transplantation.

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