Neurological Manifestations of Hypoparathyroidism.pptx
- 1. Neurological Manifestation of Hypoparathyroidism Ade Wijaya, MD – July 2025
- 2. Introduction Parathyroid hormone (PTH) regulates calcium and phosporus in the body Hypoparathyroidism causing hypocalcemia and hyperphosphatemia A rare metabolic disorder, with an estimated prevalence of 37 cases per 100.000 Etiology: most commond due to thyroid surgery. Only 1-5 % becomes permanent Can also causing Fahr Disease / Fahr Syndrome Supit VD, Kurniawan D, Fatimah E. Fahr syndrome and neurological manifestations in hypoparathyroidism patients. Radiology Case Reports. 2024 Apr 1;19(4):1248-53. Arruda AC, Guerra AC, Pessoa CH, Marquezine GF, Delfino VD. Hypoparathyroidism and Fahr’s syndrome: case series. Brazilian Journal of Nephrology. 2021 May 17;44:592-6.
- 3. Clinical Presentation Paresthesia Spasms (tetany) Positive Chvostek sign Parkinsonism and extrapyramidal symptoms Cataracts QT interval prolongation Severe hypocalcemia (calcium < 5 mg/dL) can result in seizures and cardiac arrhytmias Abate EG, Clarke BL. Review of hypoparathyroidism. Frontiers in endocrinology. 2017 Jan 16;7:172. Cating-Cabral MT, Clarke B. Epidemiology of hypoparathyroidism. InThe Parathyroids: Basic and Clinical Concepts: Third Edition 2014 Sep 5 (pp. 707-717). Elsevier Inc.. Supit VD, Kurniawan D, Fatimah E. Fahr syndrome and neurological manifestations in hypoparathyroidism patients. Radiology Case Reports. 2024 Apr 1;19(4):1248-53.
- 4. Pathophysiology The reactive astrocytes and microglia accumulated around calcification deposits suggest an ongoing mild inflammatory process It takes around 8-10 years to cause basal ganglia calcification from hypoparathyroidism alone Intracranial calcification may worsen with advancing age and unregulated calcium serum level Mechanism of brain calcification in HP has been linked to long duration of hyperphosphatemia and high calcium-phosphate product, resulting from the disease itself and from long-term treatment with activated vitamin D and calcium Leyloh PA, Islamiyah WR. Fahr disease with seizure as clinical manifestation: a case series. Fahr Disease with Seizure as Clinical Manifestation: A Case Series. 2021 Sep 9;84(1):7-7. Supit VD, Kurniawan D, Fatimah E. Fahr syndrome and neurological manifestations in hypoparathyroidism patients. Radiology Case Reports. 2024 Apr 1;19(4):1248-53. Arruda AC, Guerra AC, Pessoa CH, Marquezine GF, Delfino VD. Hypoparathyroidism and Fahr’s syndrome: case series. Brazilian Journal of Nephrology. 2021 May 17;44:592-6.
- 6. Management Maintain serum calcium levels within the low-normal range The management target was to reduce symptoms, minimize the risk of kidney stones and dysfunction, as well as prevent ectopic calcium deposition in tissues Calcium and vitamin D supplementation AED: levetiracetam
- 7. Summary Hypoparathyroidism most commonly caused by thyroid surgery Causing disturbance of calcium and phosporus regulation in human body May progress into Fahr disease brain abnormal calcifications Neurological symptoms including seizures, parkinsonism, and cognitive impairment Treatment: calcium, vitamin D Recommended AED option is levetiracetam
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