Recurrent Dystonic Crisis and Rhabdomyolysis Treated with Dantrolene in Two Patients with Aromatic L-Amino Acid Decarboxylase Deficiency

AbstractAromatic L-amino acid decarboxylase (AADC) deficiency is a rare, autosomal recessive inborn error of metabolism in which several neurotransmitters including serotonin, dopamine, norepinephrine and epinephrine are deficient. Symptoms typically appear in the first year of life and include oculogyric crises and dystonia, hypotonia, and global developmental delay. Dystonia is of particular concern as a dystonic storm can ensue leading to rhabdomyolysis. Rhabdomyolysis can become life-threating and therefore its recognition and prompt management is of significant importance. Here we present two cases of patients with AADC deficiency and a history of dystonic crisis causing rhabdomyolysis. We hypothesize that in addition to the hypodopaminergic, a hypercholinergic state is contributing to the pathophysiology of dystonia in AADC deficiency, as well as to the associated rhabdomyolysis. We were able to prevent rhabdomyolysis in both patients with using Dantrolene and we suggest using a trial of this medication in cases of sustained dystonic crisis in AADC deficiency patients.

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Aromatic L-amino acid decarboxylase deficiency: Clinical features, diagnosis, and treatment of a new inborn error of neurotransmitter amine synthesis

Neurology ◽

10.1212/wnl.42.10.1980 ◽

1992 ◽

Vol 42 (10) ◽

pp. 1980-1980 ◽

Cited By ~ 111

Author(s):

K. H. PhD ◽

R. A.H. Surtees ◽

C. R. MD ◽

P. T. Clayton

Keyword(s):

Amino Acid ◽

Clinical Features ◽

Inborn Error ◽

Diagnosis And Treatment ◽

Acid Decarboxylase ◽

Amino Acid Decarboxylase ◽

Decarboxylase Deficiency

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Atypical Presentation of Aromatic L-Amino Acid Decarboxylase (AADC) Deficiency with Developmental Epileptic Encephalopathy

Journal of Pediatric Epilepsy ◽

10.1055/s-0041-1723768 ◽

2021 ◽

Author(s):

Francesca Marchese ◽

Elena Faedo ◽

Maria Stella Vari ◽

Patrizia Bergonzini ◽

Michele Iacomino ◽

...

Keyword(s):

Amino Acid ◽

Autosomal Recessive ◽

Epileptic Encephalopathy ◽

Dopa Decarboxylase ◽

Acid Decarboxylase ◽

Homozygous Mutation ◽

Amino Acid Decarboxylase ◽

Pathogenic Variants ◽

Neurological Features ◽

Decarboxylase Deficiency

AbstractAromatic L-amino acid decarboxylase (AADC) deficiency is an autosomal recessive metabolic disorder resulting from disease-causing pathogenic variants of the dopa decarboxylase (DDC) gene. The neurological features of AADC deficiency include early-onset hypotonia, oculogyric crises, ptosis, dystonia, hypokinesia, impaired development, and autonomic dysfunction. We report a patient with genetically confirmed AADC deficiency presenting with developmental epileptic encephalopathy (DEE). We report a boy with severe intractable epileptic spasms and DEE. The patient was evaluated for cognitive and neurologic impairment. Exome sequencing revealed a homozygous mutation (NM_000790.4:c.121C > A; p.Leu41Met) in the DDC gene. This case expands the clinical spectrum of AADC deficiency and strengthens the association between dopa decarboxylase deficiency and epilepsy. Additional studies are warranted to clarify the mechanisms linking dopa decarboxylase dysfunction to DEE.

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Aromatic Amino Acid Decarboxylase Deficiency Not Responding to Pyridoxine and Bromocriptine Therapy: Case Report and Review of Response to Treatment

Journal of Central Nervous System Disease ◽

10.4137/jcnsd.s12938 ◽

2014 ◽

Vol 6 ◽

pp. JCNSD.S12938 ◽

Cited By ~ 4

Author(s):

Majid Alfadhel ◽

Rana Kattan

Keyword(s):

Amino Acid ◽

Autosomal Recessive ◽

Poor Response ◽

Response To Treatment ◽

Acid Decarboxylase ◽

Amino Acid Decarboxylase ◽

Aromatic Amino Acid Decarboxylase ◽

Clinical Complications ◽

Progressive Encephalopathy ◽

Decarboxylase Deficiency

Aromatic L-amino acid decarboxylase (AADC) deficiency (MIM #608643) is an autosomal recessive inborn error of monoamines. It is caused by a mutation in the DDC gene that leads to a deficiency in the AADC enzyme. The clinical features of this condition include a combination of dopamine, noradrenaline, and serotonin deficiencies, and a patient may present with hypotonia, oculogyric crises, sweating, hypersalivation, autonomic dysfunction, and progressive encephalopathy with severe developmental delay. We report the case of an 8-month-old boy who presented with the abovementioned symptoms and who was diagnosed with AADC deficiency based on clinical, biochemical, and molecular investigations. Treatment with bromocriptine and pyridoxine showed no improvement. These data support the findings observed among previously reported cohorts that showed poor response of this disease to current regimens. Alternative therapies are needed to ameliorate the clinical complications associated with this disorder.

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Aromatic L-Amino Acid Decarboxylase Deficiency: Diagnostic Methodology

Clinical Chemistry ◽

10.1093/clinchem/38.12.2405 ◽

1992 ◽

Vol 38 (12) ◽

pp. 2405-2410 ◽

Cited By ~ 60

Author(s):

K Hyland ◽

P T Clayton

Keyword(s):

Cerebrospinal Fluid ◽

Amino Acid ◽

Inborn Error ◽

Gas Chromatography Mass Spectrometry ◽

Dopa Decarboxylase ◽

Acid Decarboxylase ◽

Amino Acid Decarboxylase ◽

Dopamine Biosynthesis ◽

Hydroxyindoleacetic Acid ◽

Decarboxylase Deficiency

Abstract Aromatic L-amino acid decarboxylase (EC. 4.1.1.28) deficiency is a newly described inborn error of metabolism that affects serotonin and dopamine biosynthesis. The major biochemical markers for this disease are increases of L-dopa, 3-methoxytyrosine, and 5-hydroxytryptophan in urine, plasma, and cerebrospinal fluid together with decreased cerebrospinal fluid concentrations of homovanillic acid and 5-hydroxyindoleacetic acid. In addition, concentrations of vanillactic acid are increased in the urine. Specific HPLC and gas chromatography-mass spectrometry methods are described that permit the identification and measurement of these metabolites in the above body fluids. Simplified assays for human plasma L-dopa decarboxylase and liver L-dopa and 5-hydroxytryptophan decarboxylase, used to demonstrate the enzyme deficiency, are also reported.

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