Treatable Intellectual Disability

Cerebral Folate Receptor-α Deficiency

BIOCHEMICAL DEFICIENCY

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DIAGNOSIS

Gene
FOLR1 (AR)

Diagnostic Test
CSF Tetrahydrofolate

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SIGNS & SYMPTOMS

Neurological
Epilepsy

Non-Neurological
Cardiomyopathy

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THERAPY

Treatment
Folinic Acid

Level of Evidence
4

Clinical Practice
Standard of Care

Treatment Effect
Stabilizes clinical deterioration; improves psychomotor development/IQ, seizure control & neurological manifestations



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Cerebral Folate Receptor-α Deficiency

is an inherited brain-specific folate transport defect that is caused by mutations in the folate receptor 1 (FOLR1) gene coding for folate receptor alpha (FRalpha). Patients carrying FOLR1 mutations developed progressive movement disturbance, psychomotor decline, and epilepsy and showed severely reduced folate concentrations in the cerebrospinal fluid (CSF) as well as hypomyelination on MRI. CSF folate concentrations, as well as glial choline and inositol depletion, were restored by folinic acid therapy and preceded clinical improvements.

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