title: Outcomes analysis of verbal dyspraxia in classic galactosemia.
abstract: OBJECTIVE
  This study evaluates a genotype/phenotype relationship between developmental verbal dyspraxia (DVD) and the common, missense mutation of the galactose-1-phosphate uridyltransferase gene, Q188R, in patients with classic galactosemia (G/G).
  
  
  METHODS
  As part of this study, we devised a questionnaire for "speech problems" to be completed by the patient\'s clinician. To validate the questionnaire and determine its accuracy in detecting DVD, we analyzed questionnaire responses for 21 patients by testing them independently and directly for DVD through a speech pathologist blinded to the patients' genotype.
  
  
  RESULTS
  We found that the questionnaire had a sensitivity of 0.56 and a specificity of 0.75. We then calculated the prevalence of DVD for a larger set of 113 patients with G/G galactosemia whose biochemical phenotype, molecular genotypes, and clinical status were known. The prevalence of "speech problems" from raw data were 50 of 113 (44.2%). After adjusting for misclassification, 43 (38.1%) were classified as cases of DVD. Using multivariate, logistic, regression analyses we found a significant interaction between genotype and mean red blood cell (RBC) galactose-1-phosphate (Gal-1-P). When corrected, using mean RBC Gal-1-P < h 3.28 mg%, the Q188R/Q188R genotype was the best predictor of DVD. There was a significant risk (odds ratio = 9.6, p = 0.0504) of having DVD associated with homozygosity for Q188R compared with other genotypes.
  
  
  CONCLUSIONS
  We conclude that homozygosity for Q188R mutations in the GALT gene is a significant risk factor for DVD. However, poor metabolic control obviates this relationship as indicated by RBC Gal-1-P greater than 3.28 mg%.
authors.affiliation: Department of Epidemiology, Emory University School of Public Health, Atlanta, Georgia, USA.
authors.forename: A
authors.initials: A
authors.lastname: Robertson
authors.forename: R H
authors.initials: RH
authors.lastname: Singh
authors.forename: N V
authors.initials: NV
authors.lastname: Guerrero
authors.forename: M
authors.initials: M
authors.lastname: Hundley
authors.forename: L J
authors.initials: LJ
authors.lastname: Elsas
mesh_terms: D001072:Apraxias / Q000150:complications / Q000235:genetics / Q000503:physiopathology*; D005693:Galactosemias / Q000150:complications* / Q000235:genetics; D006801:Humans; D011795:Surveys and Questionnaires