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What Is Cerebral Folate Deficiency? Understanding This Neurological Disorder

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Medically approved by Dr Tim Trodd
Family Medicine, Functional Medicine, General Practice
September 29, 2025

Cerebral Folate Deficiency (CFD) is a neurological disorder characterised by low levels of 5-methyltetrahydrofolate (5-MTHF), the active form of folate, in the cerebrospinal fluid despite normal folate levels outside the nervous system. This deficiency results in impaired folate transport to the brain, leading to various neuropsychiatric and developmental symptoms. 

Causes of Cerebral Folate Deficiency 

The condition is caused by mutations in the FOLR1 gene, which encodes the folate receptor alpha (FRα), or by the presence of autoantibodies against this receptor, which block folate transport across the blood-brain barrier. 

Symptoms of Cerebral Folate Deficiency 

Symptoms can include seizures, developmental delays, movement disorders, and cognitive impairment. Early diagnosis and treatment with folinic acid or other forms of folate can improve outcomes, as it helps restore folate levels in the brain and mitigate neurological deficits. 

Connection to Autism and PANS/PANDAS 

More recently, we have found that Folate Receptor Antibodies are commonly present in cases of Autism and PANS/PANDAS. For further insights, please refer to the OT&P blogs that expand on this topic. 

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Dr Tim Trodd

Family Medicine, Functional Medicine, General Practice
  • MBBS (London)
  • DCH (London)
  • DRCOG (UK)
  • MRCGP (UK)
  • FHKAM (Family Medicine)

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References

  1. Bobrowski-Khoury, N., Sequeira, J.M. and Quadros, E.V. (2023) 'Brain uptake of folate forms in the presence of folate receptor alpha antibodies in young rats: folate and antibody distribution', Nutrients, 15(5), pp. 1167. Available at: https://www.mdpi.com/2072-6643/15/5/1167 
  2. Herbert, V. and Tisman, G. (1973) 'Effects of deficiencies of folic acid and vitamin B12 on central nervous system function and development', in Gaull, G.E. (ed.) Biology of Brain Dysfunction. Boston, MA: Springer, pp. 373–392. Available at: http://link.springer.com/10.1007/978-1-4684-2667-0_10 
  3. Hershey, T. (2016) 'Have you ruled out medical illness in the presumptive psychiatric patient?', Semantic Scholar. Available at: https://www.semanticscholar.org/paper/da8805a0d8d46fe8735c5b439b6c538a25423805 
  4. Reynolds, E.H. (2006) 'Trials that matter: should we routinely measure homocysteine levels and treat mild hyperhomocysteinaemia?', Annals of Internal Medicine, 145(3), pp. 200-608. Available at: https://www.acpjournals.org/doi/10.7326/0003-4819-145-3-200608010-00011 
  5. Frye, R.E., Sequeira, J.M. and Quadros, E.V. (2022) 'Cerebral folate deficiency syndrome: early diagnosis, intervention and treatment strategies', Nutrients, 14(15), pp. 3096. Available at: https://www.mdpi.com/2072-6643/14/15/3096/pdf?version=1659433412 
  6. Wang, Y. et al. (2023) 'Case report: cerebral folate deficiency caused by FOLR1 variant', PMC, Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11424398/ 
  7. Desai, A. et al. (2020) 'Cerebral folate deficiency: a report of two affected siblings', PMC, Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10123369/ 
  8. Zhang, Y. et al. (2020) 'First case report of cerebral folate deficiency caused by a novel mutation of FOLR1 gene in a Chinese patient', PMC, Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC7691102/ 
  9. Liu, Y. et al. (2016) 'Late diagnosis of cerebral folate deficiency: fewer seizures with folinic acid in adult siblings', PMC, Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4817904/ 
  10. Zamani, P. et al. (2017) 'Folate nutrition and blood-brain barrier dysfunction', PMC, Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC5385290/ 
  11. Frye, R.E. et al. (2020) 'Pharmacoresistant epilepsy in childhood: think of the cerebral folate deficiency, a treatable disease', PMC, Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC7690394/ 

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