Pyridoxine-dependent seizures in Dutch patients: diagnosis by elevated urinary alpha-aminoadipic semialdehyde levels.
BACKGROUND
Pyridoxine-dependent seizures (PDS) is a rare, autosomal recessively inherited disorder. Recently alpha-aminoadipic semialdehyde (alpha-AASA) dehydrogenase deficiency was identified as a major cause of PDS, which causes accumulation of both alpha-AASA and pipecolic acid (PA) in body fluids.


METHODS
We studied urinary and plasma alpha-AASA and PA levels in 12 Dutch clinically diagnosed patients with PDS.


RESULTS
Alpha-AASA was elevated in both urine and plasma in 10 patients. In these patients plasma PA levels were also elevated but urinary PA levels were normal.


CONCLUSIONS
In all patients with clinically definite PDS, and in most patients with probable or possible PDS, the clinical diagnosis of PDS could be confirmed at the metabolite level. Non-invasive urinary screening for alpha-AASA accumulation provides a reliable tool to diagnose PDS and can save these patients from the classical and potentially dangerous pyridoxine withdrawal test to prove PDS.
Bok
Levinus A
LA
Department of Paediatrics, Máxima Medical Center, Veldhoven, The Netherlands. L.Bok@mmc.nl
Struys
Eduard
E
Willemsen
Michel A A P
MA
Been
Jasper V
JV
Jakobs
Cornelis
C
D000444:Aldehyde Dehydrogenase / Q000097:blood / Q000652:urine; D015415:Biomarkers / Q000097:blood / Q000652:urine; D005260:Female; D006801:Humans; D020167:Hyperlysinemias / Q000175:diagnosis*; D009426:Netherlands; D010875:Pipecolic Acids / Q000097:blood / Q000652:urine; D011736:Pyridoxine / Q000627:therapeutic use; D012640:Seizures / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D014803:Vitamin B Complex / Q000627:therapeutic use
D015415:Biomarkers; D010875:Pipecolic Acids; D014803:Vitamin B Complex; C089507:ALDH7A1 protein, human; D000444:Aldehyde Dehydrogenase; D011736:Pyridoxine