fatal familial insomnia is a prion disease of the brain. as the disease progresses, the person becomes stuck in a state of pre-sleep limbo, or hypnagogia, which is the state just before sleep in healthy individuals.  both people with ffi and those with familial creutzfeldt–jakob disease (fcjd) carry a mutation at codon 178 of the prion protein gene.
 confirmation of the familial form is by genetic testing. the man, known only as silvano, decided in a rare moment of consciousness to be recorded for future studies and to donate his brain for research in hopes of finding a cure for future victims.  in 2011, the first reported case in the netherlands was of a 57-year-old man of egyptian descent. other research interests involve identifying biomarkers to track the progression of prion disease in living people.
the disease is currently incurable and has a mean course of 18 months, ultimately leading to death. the presence of methionine at codon 129 is distinct for ffi compared to valine at the same position in familial creutzfeldt-jakob disease (fcjd). ffi is described to mainly affect the thalamus with a propensity for anterior ventral and mediodorsal thalamic nuclei.
the disease leads to death eventually, and the course can range from 7 to 36 months, with a mean of 18 months.  the disease course can last from 7 to 36 months, with an average duration of 18 months leading to eventual death. patients and families should be thoroughly educated about the fatal course of ffi. this book is distributed under the terms of the creative commons attribution 4.0 international license (/licenses/by/4.0/), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, a link is provided to the creative commons license, and any changes made are indicated.
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