Dear Dr. Roach: What can you tell me about Fahr disease? I had an MRI, and I read the term on the report and was concerned because I hadn’t been told about it. I asked my provider about it, and he told me that it usually is diagnosed when someone is young. I am soon to be 80 years old. His advice was that if it had not shown up before now, it will not now that I am older.
Dear B.P.: Fahr disease, also called “idiopathic basal ganglia calcification,” is a rare disease of the brain, with symptoms similar to Parkinson’s disease. It also can cause other types of movement disorders. Symptoms can come on any time from adolescence to age 60 or so. One way the diagnosis is made is when people have symptoms suggestive of the disease and an MRI scan shows calcium deposits in a part of the brain called the “basal ganglia,” which is responsible for coordination of movement.
However, about 1 percent of people have similar findings on their brain scan (when obtained for another reason, as I think your scan must have been) but have none of the symptoms of Fahr disease.
In fact, a study from Germany done in the 1990s showed that basal ganglia calcifications did not put people at risk for other neurological conditions.
So, I think that this is an example of medicine learning that imaging studies, especially MRI, show conditions that we thought were likely to cause specific problems, but in fact, may be found in people with no problems and who will never get those specific problems.
I agree with the good advice your provider gave you.
Dr. Roach writes: A recent column from a man asking for alternatives to coronary bypass surgery generated many letters with the same question: Why not advise a change in diet as an alternative to surgery?
There are two reasons. The first is that it’s not an alternative to surgery: It’s a medical recommendation that should be made for every person with diagnosed coronary disease. Nearly all people can improve their diet. While a vegan diet was the most common recommendation I received, it still is not clear that a vegan diet is most likely to reduce coronary disease. In the vast literature on diet, there are only a few well-done studies that show a benefit.
The clearest benefit has been from the Mediterranean diet, but a very-low-fat, plant-based diet, in combination with stress reduction and smoking cessation, has been shown to help reverse coronary lesions.
The second reason is that if someone needs the arteries in his or her heart reopened, the changes in diet are not likely to reverse blockages in the time needed to prevent a heart attack.
Healthy diet changes are appropriate for all people with heart blockages, but inadequate by themselves in the short term, in people with symptoms of angina and serious blockages.
Email questions to ToYourGoodHealth@med.cornell.edu.