1
|
Dreha-Kulaczewski S, Sahoo P, Preusse M, Gkalimani I, Dechent P, Helms G, Hofer S, Steinfeld R, Gärtner J. Folate receptor α deficiency - Myelin-sensitive MRI as a reliable biomarker to monitor the efficacy and long-term outcome of a new therapeutic approach. J Inherit Metab Dis 2024; 47:387-403. [PMID: 38200656 DOI: 10.1002/jimd.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/23/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
Cerebral folate transport deficiency, caused by a genetic defect in folate receptor α, is a devastating neurometabolic disorder that, if untreated, leads to epileptic encephalopathy, psychomotor decline and hypomyelination. Currently, there are limited data on effective dosage and duration of treatment, though early diagnosis and therapy with folinic acid appears critical. The aim of this long-term study was to identify new therapeutic approaches and novel biomarkers for assessing efficacy, focusing on myelin-sensitive MRI. Clinical, biochemical, structural and quantitative MRI parameters of seven patients with genetically confirmed folate receptor α deficiency were acquired over 13 years. Multimodal MRI approaches comprised MR-spectroscopy (MRS), magnetization transfer (MTI) and diffusion tensor imaging (DTI) sequences. Patients started oral treatment immediately following diagnosis or in an interval of up to 2.5 years. Escalation to intravenous and intrathecal administration was performed in the absence of effects. Five patients improved, one with a presymptomatic start of therapy remained symptom-free, and one with inconsistent treatment deteriorated. While CSF 5-methyltetrahydrofolate and MRS parameters normalized immediately after therapy initiation, myelin-sensitive MTI and DTI measures correlated with gradual clinical improvement and ongoing myelination under therapy. Early initiation of treatment at sufficient doses, considering early intrathecal applications, is critical for favorable outcome. The majority of patients showed clinical improvements that correlated best with MTI parameters, allowing individualized monitoring of myelination recovery. Presymptomatic therapy seems to ensure normal development and warrants newborn screening. Furthermore, the quantitative parameters of myelin-sensitive MRI for therapy assessments can now be used for hypomyelination disorders in general.
Collapse
Affiliation(s)
- Steffi Dreha-Kulaczewski
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Prativa Sahoo
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Matthias Preusse
- Kinderkrankenhaus Amsterdamer Strasse, Klinik für Kinder- und Jugendmedizin, Köln, Germany
| | - Irini Gkalimani
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Dechent
- MR-Research in Neuroscience, Department of Cognitive Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Gunther Helms
- Medical Radiation Physics, Lund University, Lund, Sweden
| | - Sabine Hofer
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Robert Steinfeld
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Jutta Gärtner
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
3
|
Stezin A, Pal PK. Treatable Ataxias: How to Find the Needle in the Haystack? J Mov Disord 2022; 15:206-226. [PMID: 36065614 DOI: 10.14802/jmd.22069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
Treatable ataxias are a group of ataxic disorders with specific treatments. These disorders include genetic and metabolic disorders, immune-mediated ataxic disorders, and ataxic disorders associated with infectious and parainfectious etiology, vascular causes, toxins and chemicals, and endocrinopathies. This review provides a comprehensive overview of different treatable ataxias. The major metabolic and genetic treatable ataxic disorders include ataxia with vitamin E deficiency, abetalipoproteinemia, cerebrotendinous xanthomatosis, Niemann-Pick disease type C, autosomal recessive cerebellar ataxia due to coenzyme Q10 deficiency, glucose transporter type 1 deficiency, and episodic ataxia type 2. The treatment of these disorders includes the replacement of deficient cofactors and vitamins, dietary modifications, and other specific treatments. Treatable ataxias with immune-mediated etiologies include gluten ataxia, anti-glutamic acid decarboxylase antibody-associated ataxia, steroid-responsive encephalopathy associated with autoimmune thyroiditis, Miller-Fisher syndrome, multiple sclerosis, and paraneoplastic cerebellar degeneration. Although dietary modification with a gluten-free diet is adequate in gluten ataxia, other autoimmune ataxias are managed by short-course steroids, plasma exchange, or immunomodulation. For autoimmune ataxias secondary to malignancy, treatment of tumor can reduce ataxic symptoms. Chronic alcohol consumption, antiepileptics, anticancer drugs, exposure to insecticides, heavy metals, and recreational drugs are potentially avoidable and treatable causes of ataxia. Infective and parainfectious causes of cerebellar ataxias include acute cerebellitis, postinfectious ataxia, Whipple's disease, meningoencephalitis, and progressive multifocal leukoencephalopathy. These disorders are treated with steroids and antibiotics. Recognizing treatable disorders is of paramount importance when dealing with ataxias given that early treatment can prevent permanent neurological sequelae.
Collapse
Affiliation(s)
- Albert Stezin
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.,Centre for Brain Research, Indian Institute of Science, Bengaluru, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| |
Collapse
|
5
|
Fernández-Eulate G, Carreau C, Benoist JF, Lamari F, Rucheton B, Shor N, Nadjar Y. Diagnostic approach in adult-onset neurometabolic diseases. J Neurol Neurosurg Psychiatry 2022; 93:413-421. [PMID: 35140137 PMCID: PMC8921565 DOI: 10.1136/jnnp-2021-328045] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/02/2022] [Indexed: 12/31/2022]
Abstract
Neurometabolic diseases are a group of individually rare but numerous and heterogeneous genetic diseases best known to paediatricians. The more recently reported adult forms may present with phenotypes strikingly different from paediatric ones and may mimic other more common neurological disorders in adults. Furthermore, unlike most neurogenetic diseases, many neurometabolic diseases are treatable, with both conservative and more recent innovative therapeutics. However, the phenotypical complexity of this group of diseases and the growing number of specialised biochemical tools account for a significant diagnostic delay and underdiagnosis. We reviewed all series and case reports of patients with a confirmed neurometabolic disease and a neurological onset after the age of 10 years, with a focus on the 36 treatable ones, and classified these diseases according to their most relevant clinical manifestations. The biochemical diagnostic approach of neurometabolic diseases lays on the use of numerous tests studying a set of metabolites, an enzymatic activity or the function of a given pathway; and therapeutic options aim to restore the enzyme activity or metabolic function, limit the accumulation of toxic substrates or substitute the deficient products. A quick diagnosis of a treatable neurometabolic disease can have a major impact on patients, leading to the stabilisation of the disease and cease of repeated diagnostic investigations, and allowing for familial screening. For the aforementioned, in addition to an exhaustive and clinically meaningful review of these diseases, we propose a simplified diagnostic approach for the neurologist with the aim to help determine when to suspect a neurometabolic disease and how to proceed in a rational manner. We also discuss the place of next-generation sequencing technologies in the diagnostic process, for which deep phenotyping of patients (both clinical and biochemical) is necessary for improving their diagnostic yield.
Collapse
Affiliation(s)
- Gorka Fernández-Eulate
- Neuro-Metabolism Unit, Reference Center for Lysosomal Diseases, Neurology Department, Pitié-Salpêtrière University Hospital, APHP, Paris, France.,Reference Center for Neuromuscular Diseases, Neuro-myology Department, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - Christophe Carreau
- Neurology Department, Saint-Louis University Hospital, APHP, Paris, France
| | - Jean-François Benoist
- Metabolic Biochemistry Laboratory, Necker Enfants Malades University Hospital, APHP, Paris-Saclay University, Paris, France
| | - Foudil Lamari
- Department of Biochemistry of Neurometabolic Diseases, Pitié-Salpêrière University Hospital, APHP, Paris, Fance
| | - Benoit Rucheton
- Department of Biochemistry of Neurometabolic Diseases, Pitié-Salpêrière University Hospital, APHP, Paris, Fance
| | - Natalia Shor
- Neuroradiology Department, Pitié-Salpêtrière University Hospital, APHP, Sorbonne University, Paris, France
| | - Yann Nadjar
- Neuro-Metabolism Unit, Reference Center for Lysosomal Diseases, Neurology Department, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| |
Collapse
|
6
|
Pujol C, Legrand A, Parodi L, Thomas P, Mochel F, Saracino D, Coarelli G, Croon M, Popovic M, Valet M, Villain N, Elshafie S, Issa M, Zuily S, Renaud M, Marelli-Tosi C, Legendre M, Trimouille A, Kemlin I, Mathieu S, Gleeson JG, Lamari F, Galatolo D, Alkouri R, Tse C, Rodriguez D, Ewenczyk C, Fellmann F, Kuntzer T, Blond E, El Hachimi KH, Darios F, Seyer A, Gazi AD, Giavalisco P, Perin S, Boucher JL, Le Corre L, Santorelli FM, Goizet C, Zaki MS, Picaud S, Mourier A, Steculorum SM, Mignot C, Durr A, Trifunovic A, Stevanin G. Implication of folate deficiency in CYP2U1 loss of function. J Exp Med 2021; 218:212651. [PMID: 34546337 PMCID: PMC8480666 DOI: 10.1084/jem.20210846] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/15/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022] Open
Abstract
Hereditary spastic paraplegias are heterogeneous neurodegenerative disorders. Understanding of their pathogenic mechanisms remains sparse, and therapeutic options are lacking. We characterized a mouse model lacking the Cyp2u1 gene, loss of which is known to be involved in a complex form of these diseases in humans. We showed that this model partially recapitulated the clinical and biochemical phenotypes of patients. Using electron microscopy, lipidomic, and proteomic studies, we identified vitamin B2 as a substrate of the CYP2U1 enzyme, as well as coenzyme Q, neopterin, and IFN-α levels as putative biomarkers in mice and fluids obtained from the largest series of CYP2U1-mutated patients reported so far. We also confirmed brain calcifications as a potential biomarker in patients. Our results suggest that CYP2U1 deficiency disrupts mitochondrial function and impacts proper neurodevelopment, which could be prevented by folate supplementation in our mouse model, followed by a neurodegenerative process altering multiple neuronal and extraneuronal tissues.
Collapse
Affiliation(s)
- Claire Pujol
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute ICM, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Assistance Publique - Hôpitaux de Paris, Hôpital de la Pitié Salpêtrière, Départements Médico-Universitaires Neuroscience 6, Paris, France.,Pasteur Institute, Centre national de la recherche scientifique UMR 3691, Paris, France
| | - Anne Legrand
- Paris University, Paris Cardiovascular Research Centre, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Centre de Référence des Maladies Vasculaires Rares - Institut national de la santé et de la recherche médicale U97, Paris, France
| | - Livia Parodi
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute ICM, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Assistance Publique - Hôpitaux de Paris, Hôpital de la Pitié Salpêtrière, Départements Médico-Universitaires Neuroscience 6, Paris, France
| | - Priscilla Thomas
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute ICM, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Assistance Publique - Hôpitaux de Paris, Hôpital de la Pitié Salpêtrière, Départements Médico-Universitaires Neuroscience 6, Paris, France.,Pasteur Institute, Centre national de la recherche scientifique UMR 3691, Paris, France
| | - Fanny Mochel
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute ICM, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Assistance Publique - Hôpitaux de Paris, Hôpital de la Pitié Salpêtrière, Départements Médico-Universitaires Neuroscience 6, Paris, France
| | - Dario Saracino
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute ICM, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Assistance Publique - Hôpitaux de Paris, Hôpital de la Pitié Salpêtrière, Départements Médico-Universitaires Neuroscience 6, Paris, France
| | - Giulia Coarelli
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute ICM, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Assistance Publique - Hôpitaux de Paris, Hôpital de la Pitié Salpêtrière, Départements Médico-Universitaires Neuroscience 6, Paris, France
| | - Marijana Croon
- Cologne Excellence Cluster for Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
| | - Milica Popovic
- Cologne Excellence Cluster for Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
| | - Manon Valet
- Sorbonne University, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Institut de la Vision, Paris, France
| | - Nicolas Villain
- Sorbonne University, Assistance Publique - Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - Shahira Elshafie
- Department of Clinical Pathology, Fayoum University, Fayoum, Egypt
| | - Mahmoud Issa
- Department of Clinical Genetics, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Stephane Zuily
- University of Lorraine, Institut national de la santé et de la recherche médicale U 1116, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Mathilde Renaud
- University of Lorraine, Institut national de la santé et de la recherche médicale U 1256, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Cécilia Marelli-Tosi
- Mécanismes Moléculaires dans les Démences Neurodégénératives, University of Montpellier, École pratique des hautes études, Institut national de la santé et de la recherche médicale, Montpellier, France; Expert Center for Neurogenetic Diseases, Centre Hospitalier Universitaire, Montpellier, France
| | - Marine Legendre
- Genetics Department, Centre Hospitalier Universitaire de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Aurélien Trimouille
- Genetics Department, Centre Hospitalier Universitaire de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Isabelle Kemlin
- Pediatric Neurology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Armand Trousseau, Groupe Hôpitaux Universitaires Est Parisien, Paris, France
| | - Sophie Mathieu
- Pediatric Neurology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Armand Trousseau, Groupe Hôpitaux Universitaires Est Parisien, Paris, France
| | - Joseph G Gleeson
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Foudil Lamari
- Metabolic Biochemistry Department, Pitié-Salpêtrière hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Daniele Galatolo
- Molecular Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, Pisa, Italy
| | - Rana Alkouri
- Metabolic Biochemistry Department, Pitié-Salpêtrière hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Chantal Tse
- Metabolic Biochemistry Department, Pitié-Salpêtrière hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Diana Rodriguez
- Pediatric Neurology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Armand Trousseau, Groupe Hôpitaux Universitaires Est Parisien, Paris, France
| | - Claire Ewenczyk
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute ICM, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Assistance Publique - Hôpitaux de Paris, Hôpital de la Pitié Salpêtrière, Départements Médico-Universitaires Neuroscience 6, Paris, France
| | - Florence Fellmann
- University of Lausanne, Service de Génétique médicale, Lausanne, Switzerland
| | - Thierry Kuntzer
- University of Lausanne, Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne, Switzerland
| | - Emilie Blond
- Department of Biochemistry and Molecular Biology, Hospices Civils de Lyon, Pierre Bénite, France
| | - Khalid H El Hachimi
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute ICM, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Assistance Publique - Hôpitaux de Paris, Hôpital de la Pitié Salpêtrière, Départements Médico-Universitaires Neuroscience 6, Paris, France.,Paris Sciences et Lettres Research University, École pratique des hautes études, Neurogenetics Unit, Paris, France
| | - Frédéric Darios
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute ICM, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Assistance Publique - Hôpitaux de Paris, Hôpital de la Pitié Salpêtrière, Départements Médico-Universitaires Neuroscience 6, Paris, France
| | | | - Anastasia D Gazi
- Pasteur Institute, Centre national de la recherche scientifique UMR 3691, Paris, France
| | | | - Silvina Perin
- Max Planck Institute for Biology of Ageing, Cologne, Germany
| | - Jean-Luc Boucher
- Paris Descartes University, Laboratoire de Chimie et Biochimie Pharmacologiques et Toxicologiques, Centre national de la recherche scientifique UMR 8601, Paris, France
| | - Laurent Le Corre
- Paris Descartes University, Laboratoire de Chimie et Biochimie Pharmacologiques et Toxicologiques, Centre national de la recherche scientifique UMR 8601, Paris, France
| | - Filippo M Santorelli
- Molecular Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, Pisa, Italy
| | - Cyril Goizet
- Genetics Department, Centre Hospitalier Universitaire de Bordeaux, University of Bordeaux, Bordeaux, France
| | - Maha S Zaki
- Department of Clinical Genetics, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Serge Picaud
- Sorbonne University, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Institut de la Vision, Paris, France
| | - Arnaud Mourier
- Bordeaux University, Centre national de la recherche scientifique, Institut de Biochimie et Génétique Cellulaires, UMR 5095, Bordeaux, France
| | - Sophie Marie Steculorum
- Group Neurocircuit and Function, Max Planck Institute for Metabolism Research, Cologne, Germany
| | - Cyril Mignot
- Genetics and Cytogenetics Department, Centre de Référence Déficiences Intellectuelles de Causes Rares, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Alexandra Durr
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute ICM, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Assistance Publique - Hôpitaux de Paris, Hôpital de la Pitié Salpêtrière, Départements Médico-Universitaires Neuroscience 6, Paris, France
| | - Aleksandra Trifunovic
- Cologne Excellence Cluster for Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
| | - Giovanni Stevanin
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute ICM, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Assistance Publique - Hôpitaux de Paris, Hôpital de la Pitié Salpêtrière, Départements Médico-Universitaires Neuroscience 6, Paris, France.,Paris Sciences et Lettres Research University, École pratique des hautes études, Neurogenetics Unit, Paris, France
| |
Collapse
|
7
|
Steriade C, Titulaer MJ, Vezzani A, Sander JW, Thijs RD. The association between systemic autoimmune disorders and epilepsy and its clinical implications. Brain 2021; 144:372-390. [PMID: 33221878 DOI: 10.1093/brain/awaa362] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 12/12/2022] Open
Abstract
Systemic autoimmune disorders occur more frequently in patients with epilepsy than in the general population, suggesting shared disease mechanisms. The risk of epilepsy is elevated across the spectrum of systemic autoimmune disorders but is highest in systemic lupus erythematosus and type 1 diabetes mellitus. Vascular and metabolic factors are the most important mediators between systemic autoimmune disorders and epilepsy. Systemic immune dysfunction can also affect neuronal excitability, not only through innate immune activation and blood-brain barrier dysfunction in most epilepsies but also adaptive immunity in autoimmune encephalitis. The presence of systemic autoimmune disorders in subjects with acute seizures warrants evaluation for infectious, vascular, toxic and metabolic causes of acute symptomatic seizures, but clinical signs of autoimmune encephalitis should not be missed. Immunosuppressive medications may have antiseizure properties and trigger certain drug interactions with antiseizure treatments. A better understanding of mechanisms underlying the co-existence of epilepsy and systemic autoimmune disorders is needed to guide new antiseizure and anti-epileptogenic treatments. This review aims to summarize the epidemiological evidence for systemic autoimmune disorders as comorbidities of epilepsy, explore potential immune and non-immune mechanisms, and provide practical implications on diagnostic and therapeutic approach to epilepsy in those with comorbid systemic autoimmune disorders.
Collapse
Affiliation(s)
- Claude Steriade
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Maarten J Titulaer
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annamaria Vezzani
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, Bucks, UK.,Stichting Epilepsie Instellingen Nederland - (SEIN), Heemstede, The Netherlands
| | - Roland D Thijs
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Stichting Epilepsie Instellingen Nederland - (SEIN), Heemstede, The Netherlands.,Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
8
|
Mandia D, Shor N, Benoist JF, Nadjar Y. Adolescent-Onset and Adult-Onset Vitamin-Responsive Neurogenetic Diseases: A Review. JAMA Neurol 2021; 78:483-490. [PMID: 33427863 DOI: 10.1001/jamaneurol.2020.4911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Vitamin-responsive inherited diseases are among the rare genetic disorders with a specific pharmacological treatment. Many of these conditions have a prominent neurological phenotype that is mainly reported in children. Being rare and often strikingly different in adult-onset forms, they are still poorly known in the medical fields specific to adults. Observation This article reviews all articles reporting cases of patients with a genetically confirmed inherited vitamin-responsive neurological disease and neurological onset after the age of 10 years. On this basis, 24 different diseases are described, involving vitamins A, B1, B2, B3, B6, B8, B9, B12, E, and tetrahydrobiopterin (BH4). Information such as clinical symptoms, disease course, imaging studies, biochemical alterations, and response to treatment present an overall picture of these patients. Conclusions and Relevance Vitamin-responsive neurogenetic diseases represent a group of rare conditions that are probably underdiagnosed in adults and may have a dramatic response to treatment when started early in the course of the disease. In this review, main features of the adult-onset forms are defined and simple key messages are provided to help identify clinical situations when specific diagnostic tests should be performed and/or vitamins should be promptly administered.
Collapse
Affiliation(s)
- Daniele Mandia
- Neuro-Metabolism Unit, Reference Center for Lysosomal Diseases, Neurology Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - Natalia Shor
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.,Sorbonne University, Paris VI University, Paris, France
| | - Jean-François Benoist
- Metabolic Biochemistry Laboratory, Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yann Nadjar
- Neuro-Metabolism Unit, Reference Center for Lysosomal Diseases, Neurology Department, Hôpital Pitié-Salpêtrière, Paris, France
| |
Collapse
|