Generalized tonic-clonic seizures as the initial symptom of late-onset Krabbe disease: A case report

Sifen Xie¹¹Zuying Kuang¹¹Mengqiu Pan¹¹Kanghua Zhang¹¹Jinlong Ye¹¹Bo Li¹¹Sheng Luo^2*Zhanhang Wang¹

• ¹Guangdong 999 Brain Hospital, Guangzhou, China
• ²The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

Krabbe disease (KD), also known as globoid cell leukodystrophy, is a rare autosomal recessive neurodegenerative disorder caused by pathogenic variants in the GALC gene.While infantile-onset KD is prevalent globally, adult-onset KD is frequently presented in East Asian populations and typically manifests with progressive spastic paraparesis.We herein report a unique case of a 28-year-old male who initially presented with generalized tonic-clonic seizures, rather than the classic gait disturbance. Brain MRI revealed symmetrical white matter lesions and early cortical involvement. Genetic testing revealed compound heterozygous GALC variants (c.908C>T/p.Ser303Phe and c.136G>T/p.Asp46Tyr).Subsequent enzyme assays confirmed low galactocerebrosidase activity. This case broadens the clinical spectrum of adult-onset KD and highlights the importance of considering KD in the differential diagnosis of adult epilepsy with progressive neurological symptoms.