may also be identified as a marker for Krabbe disease. A 2011 study discovered that individuals with Krabbe disease, more so in later-onset individuals, tend to have an abnormal increase in CSF protein concentration. The disease may be diagnosed by its characteristic grouping of certain cells (multinucleated globoid cells), nerve demyelination and degeneration, and destruction of brain cells. Special stains for myelin (e.g., luxol fast blue) may be used to aid diagnosis. New York, Missouri and Kentucky include Krabbe in the newborn screening panel. Indiana started screening in 2020. Treatment Although there is no known cure for Krabbe disease, bone marrow transplantation or hematopoietic stem cell transplantation (HSCT) has been shown to benefit cases early in the course of the disease. Generally, treatment for the disorder is symptomatic and supportive. Physical therapy may help maintain or increase muscle tone and circulation. A 15-year study on the developmental outcomes of children with Krabbe disease who underwent HSCT in the first seven weeks after birth found that patients have a better prognosis for both lifespan and functionality, with a slower progression of the disease. Even symptomatic individuals with later-onset Krabbe disease may benefit from HSCT if diagnosed early enough. Umbilical-cord blood is typically used as the source for the transplant stem cells. Clinical trials for gene therapy are currently enrolling patients. Management Symptom management can be particularly difficult for individuals with infantile onset, as symptoms tend to progress rapidly. Because there is no treatment for Krabbe disease, management of the condition is typically supportive and aimed at alleviating symptoms. Frequent evaluation is encouraged in order to anticipate the onset of, and preparation for, certain symptoms. Physical therapy can help to alleviate motor difficulties and increase strength, mobility, and flexibility. Gastrostomy tubes are used to circumvent feeding difficulties and prevent aspiration. A simultaneous gastrostomy tube insertion and Nissen fundoplication procedure is commonly performed to prevent the need for a secondary surgical procedure. Individuals with Krabbe disease with severe motor deficits tend to be more susceptible to overfeeding, as they require less calorie consumption and thus consume fewer calories than what caretakers may expect. There is also evidence that routine vaccines may accelerate disease progression; many individuals with Krabbe disease tend to not follow traditional vaccination procedures. Prognosis In infantile Krabbe disease, death usually occurs in early childhood. A 2011 study found one-, two-, and three-year survival rates of 60%, 26%, and 14%, respectively,