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Fatal familial insomnia(FFI)

MedGen UID:
104768
Concept ID:
C0206042
Disease or Syndrome
Synonym: FFI
SNOMED CT: FFI - Familial fatal insomnia (83157008); Familial fatal insomnia (83157008); Fatal familial insomnia (83157008)
Modes of inheritance:
Autosomal dominant inheritance
MedGen UID:
141047
Concept ID:
C0443147
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in heterozygotes. In the context of medical genetics, an autosomal dominant disorder is caused when a single copy of the mutant allele is present. Males and females are affected equally, and can both transmit the disorder with a risk of 50% for each child of inheriting the mutant allele.
 
Gene (location): PRNP (20p13)
 
Monarch Initiative: MONDO:0010808
OMIM®: 600072
Orphanet: ORPHA466

Disease characteristics

Excerpted from the GeneReview: Genetic Prion Disease
Genetic prion disease generally manifests with cognitive difficulties, ataxia, and myoclonus (abrupt jerking movements of muscle groups and/or entire limbs). The order of appearance and/or predominance of these features and other associated neurologic and psychiatric findings vary. The three major phenotypes of genetic prion disease are genetic Creutzfeldt-Jakob disease (gCJD), fatal familial insomnia (FFI), and Gerstmann-Sträussler-Scheinker (GSS) syndrome. Although these phenotypes display overlapping clinical and pathologic features, recognition of these phenotypes can be useful when providing affected individuals and their families with information about the expected clinical course. The age at onset typically ranges from 50 to 60 years. The disease course ranges from a few months in gCJD and FFI to a few (up to 4, and in rare cases up to 10) years in GSS syndrome. [from GeneReviews]
Authors:
Inga Zerr  |  Matthias Schmitz   view full author information

Additional descriptions

From OMIM
Fatal familial insomnia is a prion disorder showing autosomal dominant inheritance. It is clinically characterized by insomnia with or without a diurnal dreaming state, hallucinations, delirium, and dysautonomia preceding motor and cognitive deterioration. FFI is specifically associated with the asp178-to-asn mutation of the PRNP gene (D178N; 176640.0010) when the amino acid at position 129 is methionine (M129V; 176640.0005). The D178N mutation and the val129 allele results in Creutzfeldt-Jacob disease (CJD; 123400) (see 176640.0007) (Goldfarb et al., 1992). CJD typically presents with dementia, ataxia, myoclonus, and other abnormal movements; however, there is considerable clinical and pathologic overlap between FFI and CJD, and some individuals with D178N and met129 may present with a phenotype suggestive of CJD. Thus, FFI and CJD may be viewed as extremes of a phenotypic spectrum (summary by Zarranz et al., 2005).  http://www.omim.org/entry/600072
From MedlinePlus Genetics
Prion disease represents a group of conditions that affect the nervous system in humans and animals. In people, these conditions impair brain function, causing changes in memory, personality, and behavior; a decline in intellectual function (dementia); and abnormal movements, particularly difficulty with coordinating movements (ataxia). The signs and symptoms of prion disease typically begin in adulthood and worsen with time, leading to death within a few months to several years.  https://medlineplus.gov/genetics/condition/prion-disease

Clinical features

From HPO
Urinary retention
MedGen UID:
38289
Concept ID:
C0080274
Functional Concept
Inability to completely empty the urinary bladder during the process of urination.
Weight loss
MedGen UID:
853198
Concept ID:
C1262477
Finding
Reduction of total body weight.
Constipation
MedGen UID:
1101
Concept ID:
C0009806
Sign or Symptom
Infrequent or difficult evacuation of feces.
Dysphagia
MedGen UID:
41440
Concept ID:
C0011168
Disease or Syndrome
Difficulty in swallowing.
Cerebellar ataxia
MedGen UID:
849
Concept ID:
C0007758
Disease or Syndrome
Cerebellar ataxia refers to ataxia due to dysfunction of the cerebellum. This causes a variety of elementary neurological deficits including asynergy (lack of coordination between muscles, limbs and joints), dysmetria (lack of ability to judge distances that can lead to under- or overshoot in grasping movements), and dysdiadochokinesia (inability to perform rapid movements requiring antagonizing muscle groups to be switched on and off repeatedly).
Dysarthria
MedGen UID:
8510
Concept ID:
C0013362
Mental or Behavioral Dysfunction
Dysarthric speech is a general description referring to a neurological speech disorder characterized by poor articulation. Depending on the involved neurological structures, dysarthria may be further classified as spastic, flaccid, ataxic, hyperkinetic and hypokinetic, or mixed.
Abnormal autonomic nervous system physiology
MedGen UID:
8511
Concept ID:
C0013363
Disease or Syndrome
A functional abnormality of the autonomic nervous system.
Myoclonus
MedGen UID:
10234
Concept ID:
C0027066
Finding
Very brief, involuntary random muscular contractions occurring at rest, in response to sensory stimuli, or accompanying voluntary movements.
Dementia
MedGen UID:
99229
Concept ID:
C0497327
Mental or Behavioral Dysfunction
A loss of global cognitive ability of sufficient amount to interfere with normal social or occupational function. Dementia represents a loss of previously present cognitive abilities, generally in adults, and can affect memory, thinking, language, judgment, and behavior.
Insomnia
MedGen UID:
214589
Concept ID:
C0917801
Sign or Symptom
Persistent difficulty initiating or maintaining sleep.
Neuronal loss in central nervous system
MedGen UID:
342515
Concept ID:
C1850496
Finding
Cerebral cortex with spongiform changes
MedGen UID:
341885
Concept ID:
C1857934
Finding
Apnea
MedGen UID:
2009
Concept ID:
C0003578
Sign or Symptom
Lack of breathing with no movement of the respiratory muscles and no exchange of air in the lungs. This term refers to a disposition to have recurrent episodes of apnea rather than to a single event.
Fever
MedGen UID:
5169
Concept ID:
C0015967
Sign or Symptom
Body temperature elevated above the normal range.
Hyperhidrosis
MedGen UID:
5690
Concept ID:
C0020458
Finding
Abnormal excessive perspiration (sweating) despite the lack of appropriate stimuli like hot and humid weather.
Diplopia
MedGen UID:
41600
Concept ID:
C0012569
Disease or Syndrome
Diplopia is a condition in which a single object is perceived as two images, it is also known as double vision.

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
Follow this link to review classifications for Fatal familial insomnia in Orphanet.

Professional guidelines

PubMed

Goldman JS, Vallabh SM
Genet Med 2022 Oct;24(10):1993-2003. Epub 2022 Jul 12 doi: 10.1016/j.gim.2022.06.003. PMID: 35819418
Gaudino S, Gangemi E, Colantonio R, Botto A, Ruberto E, Calandrelli R, Martucci M, Vita MG, Masullo C, Cerase A, Colosimo C
Radiol Med 2017 May;122(5):369-385. Epub 2017 Jan 21 doi: 10.1007/s11547-017-0725-y. PMID: 28110369
Manix M, Kalakoti P, Henry M, Thakur J, Menger R, Guthikonda B, Nanda A
Neurosurg Focus 2015 Nov;39(5):E2. doi: 10.3171/2015.8.FOCUS15328. PMID: 26646926

Recent clinical studies

Etiology

Piñar-Morales R, Barrero-Hernández F, Aliaga-Martínez L
Med Clin (Barc) 2023 Jun 23;160(12):554-560. Epub 2023 Apr 21 doi: 10.1016/j.medcli.2023.03.001. PMID: 37088611
Chen Z, Chu M, Zhang J, Kong Y, Xie K, Cui Y, Ye H, Liu L, Li J, Wang L, Wu L
Eur J Neurol 2023 Apr;30(4):813-822. Epub 2023 Jan 23 doi: 10.1111/ene.15676. PMID: 36617541
Baldwin KJ, Correll CM
Semin Neurol 2019 Aug;39(4):428-439. Epub 2019 Sep 18 doi: 10.1055/s-0039-1687841. PMID: 31533183
Geschwind MD
Continuum (Minneap Minn) 2015 Dec;21(6 Neuroinfectious Disease):1612-38. doi: 10.1212/CON.0000000000000251. PMID: 26633779Free PMC Article
Brown K, Mastrianni JA
J Geriatr Psychiatry Neurol 2010 Dec;23(4):277-98. Epub 2010 Oct 11 doi: 10.1177/0891988710383576. PMID: 20938044

Diagnosis

Piñar-Morales R, Barrero-Hernández F, Aliaga-Martínez L
Med Clin (Barc) 2023 Jun 23;160(12):554-560. Epub 2023 Apr 21 doi: 10.1016/j.medcli.2023.03.001. PMID: 37088611
Baldwin KJ, Correll CM
Semin Neurol 2019 Aug;39(4):428-439. Epub 2019 Sep 18 doi: 10.1055/s-0039-1687841. PMID: 31533183
Ironside JW, Ritchie DL, Head MW
Handb Clin Neurol 2017;145:393-403. doi: 10.1016/B978-0-12-802395-2.00028-6. PMID: 28987186
Geschwind MD
Continuum (Minneap Minn) 2015 Dec;21(6 Neuroinfectious Disease):1612-38. doi: 10.1212/CON.0000000000000251. PMID: 26633779Free PMC Article
Araújo AQ
Arq Neuropsiquiatr 2013 Sep;71(9B):731-7. doi: 10.1590/0004-282X201301461. PMID: 24141515

Therapy

Forloni G, Roiter I, Artuso V, Marcon M, Colesso W, Luban E, Lucca U, Tettamanti M, Pupillo E, Redaelli V, Mariuzzo F, Boscolo Buleghin G, Mariuzzo A, Tagliavini F, Chiesa R, Ambrosini A
Prion 2022 Dec;16(1):66-77. doi: 10.1080/19336896.2022.2083435. PMID: 35737759Free PMC Article
Contiliani DF, Ribeiro YA, de Moraes VN, Pereira TC
Cells 2021 Jun 29;10(7) doi: 10.3390/cells10071620. PMID: 34209482Free PMC Article
Tabaee Damavandi P, Dove MT, Pickersgill RW
Prion 2017 Sep 3;11(5):293-299. doi: 10.1080/19336896.2017.1368937. PMID: 28976233Free PMC Article
Bonda DJ, Manjila S, Mehndiratta P, Khan F, Miller BR, Onwuzulike K, Puoti G, Cohen ML, Schonberger LB, Cali I
Neurosurg Focus 2016 Jul;41(1):E10. doi: 10.3171/2016.5.FOCUS15126. PMID: 27364252Free PMC Article
Schenkein J, Montagna P
MedGenMed 2006 Sep 14;8(3):65. PMID: 17406188Free PMC Article

Prognosis

Piñar-Morales R, Barrero-Hernández F, Aliaga-Martínez L
Med Clin (Barc) 2023 Jun 23;160(12):554-560. Epub 2023 Apr 21 doi: 10.1016/j.medcli.2023.03.001. PMID: 37088611
Chen Z, Chu M, Zhang J, Kong Y, Xie K, Cui Y, Ye H, Liu L, Li J, Wang L, Wu L
Eur J Neurol 2023 Apr;30(4):813-822. Epub 2023 Jan 23 doi: 10.1111/ene.15676. PMID: 36617541
Schmitz M, Villar-Piqué A, Hermann P, Escaramís G, Calero M, Chen C, Kruse N, Cramm M, Golanska E, Sikorska B, Liberski PP, Pocchiari M, Lange P, Stehmann C, Sarros S, Martí E, Baldeiras I, Santana I, Žáková D, Mitrová E, Dong XP, Collins S, Poleggi A, Ladogana A, Mollenhauer B, Kovacs GG, Geschwind MD, Sánchez-Valle R, Zerr I, Llorens F
Brain 2022 Apr 18;145(2):700-712. doi: 10.1093/brain/awab350. PMID: 35288744Free PMC Article
Calandra-Buonaura G, Provini F, Guaraldi P, Plazzi G, Cortelli P
Sleep Med Rev 2016 Apr;26:43-56. Epub 2015 Jun 3 doi: 10.1016/j.smrv.2015.05.005. PMID: 26146026
Gambetti P, Parchi P, Petersen RB, Chen SG, Lugaresi E
Brain Pathol 1995 Jan;5(1):43-51. doi: 10.1111/j.1750-3639.1995.tb00576.x. PMID: 7767490

Clinical prediction guides

Pérez-Carbonell L, Sarto J, Gaig C, Muñoz-Lopetegi A, Ruiz-García R, Naranjo L, Augé JM, Perissinotti A, Santamaria J, Iranzo A, Sánchez-Valle R
Sleep Med 2023 Aug;108:11-15. Epub 2023 May 22 doi: 10.1016/j.sleep.2023.05.010. PMID: 37302168
Foliaki ST, Smith A, Schwarz B, Bohrnsen E, Bosio CM, Williams K, Orrú CD, Lachenauer H, Groveman BR, Haigh CL
PLoS Genet 2023 Jan;19(1):e1010565. Epub 2023 Jan 19 doi: 10.1371/journal.pgen.1010565. PMID: 36656833Free PMC Article
Pérez-Carbonell L, Muñoz-Lopetegi A, Sánchez-Valle R, Gelpi E, Farré R, Gaig C, Iranzo A, Santamaria J
Sleep Med 2022 Dec;100:311-346. Epub 2022 Sep 20 doi: 10.1016/j.sleep.2022.08.027. PMID: 36182725
He R, Hu Y, Yao L, Tian Y, Zhou Y, Yi F, Zhou L, Xu H, Sun Q
Prion 2019 Jan;13(1):116-123. doi: 10.1080/19336896.2019.1617027. PMID: 31122137Free PMC Article
Lugaresi E, Provini F, Cortelli P
Sleep Med 2011 Dec;12 Suppl 2:S3-10. doi: 10.1016/j.sleep.2011.10.004. PMID: 22136896

Recent systematic reviews

Rodriguez-Porcel F, Ciarlariello VB, Dwivedi AK, Lovera L, Da Prat G, Lopez-Castellanos R, Suri R, Laub H, Walker RH, Barsottini O, Pedroso JL, Espay AJ
Tremor Other Hyperkinet Mov (N Y) 2019;9 Epub 2019 Dec 12 doi: 10.7916/tohm.v0.712. PMID: 31871824Free PMC Article

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