Autosomal dominant guanosine triphosphate cyclohydrolase I deficiency (Segawa disease)

Autosomal dominant guanosine triphosphate cyclohydrolase I (GCH‐I) deficiency (Segawa disease) is a dopa‐responsive dystonia caused by mutation of the GCH‐I gene located on 14q22.1‐q22.2. Neurohistochemical examination revealed a decrease of the tyrosine hydroxylase protein as well as its activity in the striatum and decrease of dopamine content, particularly in its ventral portion rich in D1 receptors (striatal direct pathways). Neuroimaging, clinical neurophysiological, and biochemical studies showed preservation of the structure and function of the terminal of the nigrostriatal DA neuron. Clinical neurophysiological studies showed no progressive decrement of DA activities. As the enzymatic activity of pteridine metabolism is highest in the early developmental course, it may modulate dopamine receptors maturing early in the developmental course. Its product, tetrahydrobiopterin, has higher affinity to tyrosine hydroxylase among hydroxylases. Thus, partial deficiency of tetrahydrobiopterin caused by heterozygous mutation of the GCH‐I gene decreases dopamine activity rather selectively. This affects the DA receptors that mature early and demonstrates characteristic symptoms age‐dependently along with the developmental decrement of the tyrosine hydroxylase activities at the terminals and the maturational processes of the projecting neurons of the basal ganglia. A difference in the ratio of mutant/wild‐type GCH‐I mRNA that depends on the locus of mutation may explain intrafamilial and interfamilial variation of phenotype. Ann Neurol 2003;54 (suppl 6):S32–S45