Physiotherapy and Rehabilitation in Fahr’s Disease: A Case Report

Öz

Fahr's disease is a rare neurodegenerative disorder characterized by symmetrical and bilateral calcification of the basal ganglia. The purpose of this case report is to evaluate the effects of physiotherapy and rehabilitation program on a patient with Fahr's disease. Biodex Balance System®, Functional Reach Test, Six Minute Walk Test, Short Form 36, Beck Depression Inventory, Barthel Index, and bilateral ankle goniometric measurements were assessed prior to and after completion of the 12-week physiotherapy program. The improvement was observed in static and dynamic balance scores, functional capacity, health-related quality of life, performance in activities of daily living, and depressive symptoms. Physiotherapy may be recommended in patients with Fahr's disease to increase the quality of life by maximizing functional capability and preventing or minimising secondary complications. The long-term effects of physiotherapy should be investigated in more depth in the future.

Anahtar Kelimeler

• Fahr’s disease
• neurodegenerative disorders
• physiotherapy
• rare diseases

Fahr’s Hastalığında Fizyoterapi ve Rehabilitasyon: Olgu Sunumu

Öz

Fahr’s hastalığı, bazal ganglionların simetrik ve bilateral kalsifikasyonu ile karakterize, nadir görülen nörodejeneratif bir hastalıktır. Bu olgu sunumunun amacı, Fahr’s hastalığı olan bir hastada fizyoterapi programının etkilerini değerlendirmektir. Biodex Balance System®, Fonksiyonel Uzanma Testi, Altı Dakika Yürüme Testi, Kısa Form 36, Beck Depresyon Envanteri, Barthel İndeksi ve bilateral ayak bileği gonyometrik ölçümleri 12 haftalık fizyoterapi programı başlamadan önce ve tamamlandıktan sonra değerlendirildi. Statik ve dinamik denge skorlarında, fonksiyonel kapasitede, sağlıkla ilgili yaşam kalitesinde, günlük yaşam aktiviteleri performansında ve depresif belirtilerde iyileşme gözlendi. Fahr’s hastalığı tanılı bireylerde fonksiyonel kapasiteyi en üst düzeye çıkararak yaşam kalitesini artırmak ve ikincil komplikasyonları önlemek veya en aza indirmek için fizyoterapi önerilebilir. İleride yapılacak çalışmalar ile bu hastalarda fizyoterapinin uzun vadeli etkileri daha derinlemesine araştırılmalıdır.

Anahtar Kelimeler

• Fahr
• nörodejeneratif bozukluklar
• fizyoterapi
• nadir hastalıklar

Kaynakça

1. Fahr T. Idiopathische verkalkung der hirngefasse. Zentralbl Allg Pathol. 1930;50:129-133.
2. Manyam B, Walters A, Keller I, Ghobrial M. Parkinsonism associated with autosomal dominant bilateral striopallidodentate calcinosis. Parkinsonism & Related Disorders. 2001;7(4):289-295. doi:10.1016/s1353-8020(00)00036-5.
3. Kechaou I, Boukhris I. Hypoparathyroidism and early onset dementia: Fahr syndrome should be suspected. The Pan African Medical Journal. 2018;30:82-82. doi:10.11604/pamj.2018.30.82.15587.
4. Saleem S, Aslam HM, Anwar M, et al. Fahr’s syndrome: Literature review of current evidence. Orphanet Journal of Rare Diseases. 2013;8(1):1-9. doi:10.1186/1750-1172-8-156.
5. Manyam BV. What is and what is not ‘Fahr's disease’. Parkinsonism & Related Disorders. 2005;11(2):73-80. doi:10.1016/j.parkreldis.2004.12.001.
6. Asokan AG, D’souza S, Jeganathan J, Pai S. Fahr’s syndrome-an interesting case presentation. Journal of Clinical and Diagnostic Research: JCDR. 2013;7(3):532. doi:10.7860/JCDR/2013/4946.2814.
7. Pistacchi M, Gioulis M, Sanson F, Marsala SZ. Fahr’s syndrome and clinical correlation: A case series and literature review. Folia Neuropathologica. 2016;54(3):282-294. doi:10.5114/fn.2016.62538.
8. di Biase L, Munhoz RP. Deep brain stimulation for the treatment of hyperkinetic movement disorders. Expert Review of Neurotherapeutics. 2016;16(9):1067-1078.

9. Amisha F, Munakomi S. Fahr syndrome. In StatPearls; Stat Pearls Publishing: Treasure Island, FL, USA. 2023 Jan. PMID: 32809692. Accessed March 11, 2023. https://www.ncbi.nlm.nih.gov/books/NBK560857/.
10. Cachupe WJ, Shifflett B, Kahanov L, Wughalter EH. Reliability of biodex balance system measures. Measurement in Physical Education and Exercise Science. 2001;5(2):97-108.
11. Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: A new clinical measure of balance. Journal of Gerontology. 1990;45(6):M192-M197. doi:10.1093/geronj/45.6.m192.
12. ATS statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111-7. doi: 10.1164/ajrccm.166.1.at1102.
13. Ware JE. SF-36 Health Survey: Manual And Interpretation Guide. New England Medical Center, Health Institute. 1993.
14. Beck AT, Ward C, Mendelson M, Mock J, Erbaugh J. Beck depression inventory (BDI). Arch Gen Psychiatry. 1961;4(6):561-571. doi:10.1001/archpsyc.1961.01710120031004.
15. Collin C, Wade D, Davies S, Horne V. The Barthel ADL Index: A reliability study. International Disability Studies. 1988;10(2):61-63. doi:10.3109/09638288809164103.
16. Weisman DC, Yaari R, Hansen LA, Thal LJ. Density of the brain, decline of the mind: An atypical case of Fahr disease. Archives of Neurology. 2007;64(5):756-757. doi:10.1001/archneur.64.5.756.