title: Movement disorders in adult patients with classical galactosemia.
abstract: Classical galactosemia is an autosomal recessive inborn error of metabolism leading to toxic accumulation of galactose and derived metabolites. It presents with acute systemic complications in the newborn. Galactose restriction resolves these symptoms, but long-term complications, such as premature ovarian failure and neurological problems including motor dysfunction, may occur despite adequate treatment. The objective of the current study was to determine the frequency and phenotype of motor problems in adult patients with classical galactosemia. In this cross-sectional study, adult patients with a biochemically confirmed diagnosis of galactosemia attending our clinic were assessed with an interview and neurological examination and their notes retrospectively reviewed. Patients were classified according to the presence/absence of motor dysfunction on examination. Patients with motor dysfunction were further categorized according to the presence/absence of reported motor symptoms. Forty-seven patients were included. Thirty-one patients showed evidence of motor dysfunction including: tremor (23 patients), dystonia (23 patients), cerebellar signs (6 patients), and pyramidal signs (4 patients). Tremor and dystonia were often combined (16 patients). Thirteen patients reported motor symptoms, with 8 describing progressive worsening. Symptomatic treatment was effective in 4 of 5 patients. Nonmotor neurological features (cognitive, psychiatric, and speech disorders) and premature ovarian failure were more frequent in patients with motor dysfunction. Motor dysfunction is a common complication of classical galactosemia, with tremor and dystonia the most frequent findings. Up to one third of patients report motor symptoms and may benefit from appropriate treatment. Progressive worsening is not uncommon and may suggest ongoing brain damage in a subset of patients.
authors: Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
authors: Ignacio
authors: I
authors: Rubio-Agusti
authors: Miryam
authors: M
authors: Carecchio
authors: Kailash P
authors: KP
authors: Bhatia
authors: Maja
authors: M
authors: Kojovic
authors: Isabel
authors: I
authors: Parees
authors: Hoskote S
authors: HS
authors: Chandrashekar
authors: Emma J
authors: EJ
authors: Footitt
authors: Derek
authors: D
authors: Burke
authors: Mark J
authors: MJ
authors: Edwards
authors: Robin H L
authors: RH
authors: Lachmann
authors: Elaine
authors: E
authors: Murphy
mesh_terms: D000328:Adult; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D001549:Benzamides / Q000378:metabolism; D001905:Botulinum Toxins / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005693:Galactosemias / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009069:Movement Disorders / Q000150:complications* / Q000188:drug therapy; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014282:Trihexyphenidyl / Q000627:therapeutic use; D014443:Tyrosine / Q000031:analogs & derivatives / Q000378:metabolism; D055815:Young Adult
chemical_list: D018726:Anti-Dyskinesia Agents; D001549:Benzamides; D018727:Muscarinic Antagonists; D014443:Tyrosine; C012614:1-nitrohydroxyphenyl-N-benzoylalanine; D014282:Trihexyphenidyl; D001905:Botulinum Toxins