Neurological and Neuropsychological Problems in Tyrosinemia Type I Patients

Willem G. van Ginkel, Rianne Jahja, Stephan C. J. Huijbregts, Francjan J. van Spronsen*

*Corresponding author voor dit werk

OnderzoeksoutputAcademicpeer review

26 Citaten (Scopus)
84 Downloads (Pure)

Samenvatting

Clinically, Hereditary Tyrosinemia type I (HTI) is especially characterized by severe liver dysfunction in early life. However, recurrent neurological crises are another main finding in these patients when they are treated with a tyrosine and phenylalanine restricted diet only. This is caused by the accumulation of delta-aminolevulinic acid due to the inhibitory effect of succinylacetone on the enzyme that metabolizes d-aminolevulinic acid. Due to the biochemical and clinical resemblance of these neurological crises and acute intermittent porphyria, this group of symptoms in HTI patients is mostly called porphyria-like-syndrome. The neurological crises in HTI patients disappeared after the introduction of treatment with 2-(2 nitro-4-3 trifluoro-methylbenzoyl)-1,3-cyclohexanedione (NTBC). However, if NTBC treatment is stopped for a while, severe neurological dysfunction will reappear.

If NTBC treatment is started early and given continuously, all clinical problems seem to be solved. However, recent research findings indicate that HTI patients have a non-optimal neurocognitive outcome, showing (among others) a lower IQ and impaired executive functioning and social cognition. Unfortunately the exact neuropsychological profile of these HTI patients is not known yet, neither are the exact pathophysiological mechanisms underlying these impairments. It may be hypothesized that the biochemical changes such as high blood tyrosine or low blood phenylalanine concentrations are important in this respect, but an direct toxic effect of NTBC or production of toxic metabolites (that previously characterized the disease before introduction of NTBC) cannot be excluded either. This chapter discusses the neurological and neuropsychological symptoms associated with HTI in detail. An extended section on possible underlying pathophysiological mechanisms of such symptoms is also included.

Originele taal-2English
TitelHereditary tyrosinemia: pathogenesis, screening and management
RedacteurenRM Tanguay
UitgeverijSpringer International Publishing AG
Hoofdstuk10
Pagina's111-122
Aantal pagina's12
ISBN van geprinte versie978-3-319-55779-3
DOI's
StatusPublished - 2017

Publicatie series

NaamAdvances in Experimental Medicine and Biology
UitgeverijSPRINGER INTERNATIONAL PUBLISHING AG
Volume959
ISSN van geprinte versie0065-2598

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