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Novel features in the evolution of adenylosuccinate lyase deficiency

AutorPérez-Dueñas, Belén; Sempere, Ángela; Campistol, Jaume; Alonso-Colmenero, Itziar; Díez, María; González, Verónica ; Merinero, Begoña; Desviat, Lourdes R.; Artuch, Rafael
Palabras claveD-ribose
Autism spectrum disorder
Reflex seizures
Status epilepticus
Adenylosuccinate lyase deficiency
Fecha de publicación2012
EditorSaunders College Publishing
CitaciónEuropean Journal of Paediatric Neurology 16: 343- 348 (2012)
ResumenBackground: Adenylosuccinate lyase (ADSL) deficiency is an autosomal recessive disorder of the purine synthesis which results in accumulation of succinylpurines (succinyladenosine (S-Ado) and succinylamino-imidazole carboxamide riboside (SAICAr)) in body fluids. Patients present developmental delay, often accompanied by epilepsy and autistic spectrum disorders. Objectives: To describe atypical neurological features in the evolution of three novel unrelated cases of ADSL deficiency. Patients: A 9-year-old boy with severe cognitive impairment and autistic behaviour received d-ribose therapy for one year. Drug withdrawal was associated with acute neurological deterioration, severe brain atrophy and demyelination on MRI. The second patient is a 5.5-year-old girl with mild developmental delay who presented a benign course with moderate cognitive impairment as the only feature in her evolution. The final patient is a 14-year-old boy with severe cognitive impairment who developed drug-resistant epilepsy and bathing reflex seizures, progressive spasticity in the lower limbs and thoracic deformity. Methods: SAICAr and S-Ado in urine were analysed by HPLC with diode array detection. Diagnosis was confirmed by molecular analysis of the ADSL gene. Results: An elevation of S-Ado and SAICAr excretion in urine was detected in all three patients. The patients were homozygous for the missence change p.I369L and for the novel change p.M389V. Conclusion: Drug-resistant epilepsy and specific therapeutic interventions may modify the neurological outcome in ADSL deficiency. d-ribose must be considered with caution as, in our experience, it returns no clinical benefit and drug withdrawal can precipitate status epilepticus and acute neurological deterioration. © 2011 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
Identificadoresdoi: 10.1016/j.ejpn.2011.08.008
issn: 1090-3798
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