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Pyruvate carboxylase deficiency: Metabolic characteristics and new neurological aspects
Author(s) -
GarcíaCazorla Angels,
Rabier Daniel,
Touati Guy,
ChadefauxVekemans Bernadette,
Marsac Cécile,
de Lonlay Pascale,
Saudubray JeanMarie
Publication year - 2006
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.20709
Subject(s) - hypokinesia , medicine , hypotonia , hypoglycemia , lactic acidosis , hypertonia , epilepsy , pediatrics , tachypnea , anesthesia , insulin , psychiatry , tachycardia
Abstract Objective Pyruvate carboxylase (PC) deficiency is a rare metabolic disease. Recently, therapeutic possibilities have been introduced. We aimed to report the largest series of the B type of PC deficiency, focusing on some neurological aspects that have not yet been documented. Methods We retrospectively studied nine patients with the severe neonatal form of PC deficiency diagnosed in our hospital. Detailed clinical features, brain imaging, biochemical characteristics, and global outcome are reported. Results All patients had axial hypotonia and tachypnea during the first hours of life. The initial level of consciousness was preserved in most patients. Abnormal movements (high‐amplitude tremor and hypokinesia) and bizarre ocular behavior were the most common findings, whereas epilepsy was infrequent. Brain magnetic resonance imaging mostly disclosed cystic periventricular leukomalacia. Hypoglycemia, lactic acidosis, and hypercitrullinemia were invariably found. Hyperammoniemia, hypernatremia, and high proline and lysine were frequently detected. A rapid fatal outcome was observed in most patients. Interpretation Clinical and biochemical characteristics of this deficiency are highly suggestive. Abnormal movements such as rigidity and hypokinesia (hypokinetic‐rigid syndrome) are an important hallmark and may orientate to PC deficiency when associated with severe lactic acidosis. Ann Neurol 2005