Discussion:
It is essential to emphasize that distinguishing between Fahr’s disease
and Fahr’s syndrome is crucial, in which there are specific causes for
the calcification of the basal ganglia, such as hypoparathyroidism.
Senile calcification of the basal ganglia without clinical symptoms with
no underlying cause is an incidental finding that is seen in some people
over 60 years old. These are also important differentials
Perugula and Lippmann 2016(). When
psychiatric symptoms and abnormal movements coincide with idiopathic
calcification of the brain in a patient, Fahr syndrome is suggested,
especially if it is accompanied by neurological symptoms, cognitive
deficits, and some degree of mental retardation
(Rücker, Halder et al. 2019).
The gradual onset of symptoms in this patient characterized by
behavioral changes and a lower-than-normal IQ, has been reported in
several studies Naqvi, Arshad et al.
2017Palu, Moraes et al. 2021)(, . Psychiatric
manifesting in the patient’s third decade of life, followed by movement
disorders, is consistent with the early-onset variant of Fahr’s disease
(Aghemo, Salmanzadeh et al. 2023).
Despite the co-occurrence of behavioral changes and neurological
symptoms, along with neuroimaging findings that suggest Fahr syndrome,
it has been reported that there is no clear connection between
calcifications and neurological symptoms
Pistacchi, Gioulis et al. 2016(). The
treatment goals involve providing symptomatic support. The response to
levodopa in those with Parkinsonian features is reportedly poor.
Atypical antipsychotics are the preferred choice for psychiatric
symptoms due to the coexistence of the extrapyramidal syndrome in this
group of patients (Asokan, D’souza et al.
2013).