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Features include always present findings: Restless legs and Decreased circulating ferritin concentration; and very common findings: Alopecia. 4 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Skin | 1 | Alopecia |
Brain and nerves |
FTL encodes ferritin light chain (175 aa). Stores iron in a soluble, non-toxic, readily available form. Important for iron homeostasis. Iron is taken up in the ferrous form and deposited as ferric hydroxides after oxidation. Highest expression in Whole Blood (13,155 TPM) and Cells Cultured fibroblasts (12,572 TPM).
L-ferritin deficiency is associated with mutations in the FTL gene on chromosome 19.
FTL is classified as a druggable target with score 0.0.
No consensus clinical diagnostic criteria for neuroferritinopathy have been published.
Neuroferritinopathy should be suspected in individuals with the following clinical, imaging, and family history findings. Clinical findings. Adult-onset progressive movement disorder (either chorea or dystonia) Imaging findings. Evidence of excess iron storage or accumulation on T2-weighted images from disease onset. As disease progresses, high signal on T2-weighted MRI in the caudate, globus pallidus, putamen, substantia nigra, and red nuclei is seen, followed by cystic degeneration in the caudate and putamen . Family history is consistent with autosomal dominant inheritance (e.g., affected males and females in multiple generations).
No approved treatments are currently available for L-ferritin deficiency. The disease remains an area of unmet medical need.
Evaluations Following Initial Diagnosis To establish the extent of disease and needs in an individual diagnosed with neuroferritinopathy, the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended. Table 4. Recommended Evaluations Following Initial Diagnosis in Individuals with Neuroferritinopathy
To monitor existing manifestations, the individual's response to supportive care, and the emergence of new manifestations, the following evaluations are recommended. Table 6. Recommended Surveillance for Individuals with Neuroferritinopathy
No clinical trials have been registered for L-ferritin deficiency.
2 publications have been identified in PubMed for L-ferritin deficiency. Research spans Basic Science / Preclinical (100%).
Dunaway LS (2025). [PMID: 41415386](https://pubmed.ncbi.nlm.nih.gov/41415386/). *bioRxiv*. [Basic Science / Preclinical]
Zhang T (2024). [PMID: 39276939](https://pubmed.ncbi.nlm.nih.gov/39276939/). *J Biol Chem*. [Basic Science / Preclinical]
Data assembled from 7 of 12 sources · Last updated Sep 20, 2026, 3:01 PM UTC
Online Mendelian Inheritance in Man
European rare disease database
Genetic and Rare Diseases Info Center
Common questions about L-ferritin deficiency
1 |
Generalized-onset seizure |
To date, more than 100 individuals have been identified with a pathogenic variant in FTL. The following description of the phenotypic features associated with this condition is based on these reports [, , , , , , , , , , , , , , , , , , , , , ]. Table 2. Neuroferritinopathy: Frequency of Select Features
Category | Feature | % of Persons w/Feature1 | Comment |
|---|---|---|---|
phenotype | Chorea | 50% | Affects 1 or 2 limbs at time of onset; Age of onset in adulthood Dystonia |
Motor issues | Bradykinesia | 35% | Motor issues typically progressive Dystonia |
Oral motor issues | Dysarthria | 78% | — |
Dysphonia | 48% | — | — |
Orolingual dyskinesia | 65% | — | — |
Dysphagia | 40% | — | — |
Eye issues | Abnormal EOM | 8% | — |
Cognitive deficits | Impaired verbal learning executive function | Frequencynot known | Typically subtle but progress over time |
Behavioral issues | Disinhibition, emotional lability, aggression | — | — |
Brain MRI features | Excess brain iron accumulationon T2-weighted MRI | 100% | — |
Serum ferritin levels | Low serum ferritin concentrations (20 g/L) in most males postmenopausal females | 82% of males; 100% postmenopausal females; 23% of premenopausal females | Typically w/in normal limits in premenopausal females EOM = extraocular muscle (function) 1. In 40 individuals with the FTL Movement disorder. |
Source: GeneReviews — "Neuroferritinopathy"
Penetrance is 100% .
Source: GeneReviews — "Neuroferritinopathy"
Source: GeneReviews — "Neuroferritinopathy"
Table 3. Disorders of Interest in the Differential Diagnosis of Neuroferritinopathy
Gene | Disorder | MOI | Features Overlapping w/Neuroferritinopathy | Distinguishing Features |
|---|---|---|---|---|
SCA2 | AD | Dystonia | Ataxia neuropathy (a minor feature) in SCA2 ATXN3 | — |
SCA3 | AD | Dystonia, chorea, orofacial movement disorder | Spasticity in SCA3 CP | — |
Aceruloplasminemia | AR | Early-onset movement disorder | Different MRI findings HTT | — |
Huntington disease | AD | Chorea early neuropsychiatric features | Brain imaging distinguishes diagnoses. NPC1 NPC2 | — |
Niemann-Pick type C | AR | Early-onset movement disorder | Different MRI findings | — |
PANK2 | Pantothenate kinase-associated neurodegeneration (PKAN) | AR | Very similar MRI findings incl "eye of the tiger" sign | Earlier onset in PKAN |
PLA2G6 | Infantile neuroaxonal dystrophy (INAD) (See PLA2G6-Associated Neurodegeneration.) | AR | Imaging findings resembling but distinct from neuroferritinopathy | Earlier onset in INAD PRKN |
Parkin type of early-onset Parkinson disease | AR | Early-onset movement disorder | Different MRI findings TBP | — |
SCA17 | AD | Chorea dystonia | Spasticity in SCA17 | — |
TOR1A | DYT1 early-onset isolated dystonia (DYT1) | AD | Generalized dystonia | Chorea is uncommon in DYT1 DYT1 is not assoc w/psychiatric features. Various |
Mitochondrial disorders | Various | Basal ganglia abnormalities on MRI | Different MRI findings | — |
VPS13A | Chorea-acanthocytosis (ChAc) | AR | Orofacial dyskinesia | Impaired reflexes in ChAc |
XK | McLeod neuroacanthocytosis syndrome (MLS) | XL | Absent deep tendon reflexes in MLS AD = autosomal dominant; AR = autosomal recessive; MOI = mode of inheritance; SCA = spinocerebellar ataxia; XL = X-linked Neurodegenerative disorders with brain iron accumulation (NBIA). | — |
Source: GeneReviews — "Neuroferritinopathy"
Genetic testing for FTL is available. Testing is considered confirmatory for diagnosis.
System/Concern |
|---|
Evaluation |
|---|
Comment |
|---|
Neurologic/movement disorders | Assessment by neurologist or movement disorders specialist | To incl brain MRI w/T2 or T2* sequences Psychiatric/ |
Behavioral | Assessment by neuropsychiatrist/behavioral specialist | Early neuropsychiatric features are common. |
Nutrition | Assessment by dietician/nutritionist | To incl dietary assessment, as weight loss may develop in late stages of disorder |
Activities of daily living | Assessment by developmental therapists | To incl motor, adaptive, cognitive/psychometric, speech/language evals |
Genetic counseling | By genetics professionals1 | To inform affected persons their families re nature, MOI, implications of neuroferritinopathy to facilitate medical personal decision making Family support resources |
Treatment of Manifestations in Individuals with Neuroferritinopathy Manifestation/Concern | Treatment | Considerations/Other |
Movement disorders | Levodopa, tetrabenazine, orphenadrine, benzhexol, sulpiride, diazepam, clonazepam, deanol in standard doses1 | Best administered managed by mvmt disorders specialist; Response to these treatments is only seen in some persons, as mvmt disorders can be resistant to conventional therapy; no formal treatment trials have been completed. |
Behavioral issues | Assessment by neuropsychiatrist/behavioral specialist | May be required for cognitive neurobehavioral features.; May require psychotropic medication to manage behavioral symptoms. |
Diet/Nutrition | Ongoing dietary nutritional support | To maintain caloric intake Family/Community |
Recommended Surveillance for Individuals with Neuroferritinopathy System/Concern | Evaluation | Frequency Neurologic/ |
movement disorders | Assessment of mvmt abnormalities | At each visit |
Cognition | Eval w/neuropsychologist | Annually /or as needed |
Dietary/nutritional needs | Ongoing dietary nutritional support | — |
Family/Community | Assess family need for social work support (e.g., palliative/respite care, home nursing, other local resources), care coordination, or follow-up genetic counseling if new questions arise (e.g., family planning). | At each visit Iron supplements are not recommended for affected individuals and those at risk . Iron replacement therapy with careful monitoring may be required if affected individuals develop coincidental iron deficiency anemia. |
Source: GeneReviews — "Neuroferritinopathy"
View trials for L-ferritin deficiency
Evaluation |
|---|
Frequency |
|---|
movement disorders | Assessment of mvmt abnormalities | At each visit |
Cognition | Eval w/neuropsychologist | Annually /or as needed |
Dietary/nutritional needs | Ongoing dietary nutritional support | — |
Family/Community | Assess family need for social work support (e.g., palliative/respite care, home nursing, other local resources), care coordination, or follow-up genetic counseling if new questions arise (e.g., family planning). | At each visit |
Source: GeneReviews — "Neuroferritinopathy"
Phenotype severity distribution: 2 always present features, 1 very common feature, 1 common feature.
Estimated prevalence: <1 in 1,000,000 (VERY_RARE).