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Timing of therapy and neurodevelopmental outcomes in 18 families with pyridoxine-dependent epilepsy

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  • Laura A Tseng
  • Jose E Abdenur
  • Ashley Andrews
  • Verena G Aziz
  • Levinus A Bok
  • Monica Boyer
  • Daniela Buhas
  • Hans Hartmann
  • Emma J Footitt
  • Sabine Grønborg
  • Mirian C H Janssen
  • Nicola Longo
  • Roelineke J Lunsing
  • Alex E MacKenzie
  • Frits A Wijburg
  • Sidney M Gospe
  • Curtis R Coughlin
  • Clara D M van Karnebeek
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BACKGROUND: Seventy-five percent of patients with pyridoxine-dependent epilepsy due to α-aminoadipic semialdehyde dehydrogenase deficiency (PDE-ALDH7A1) suffer intellectual developmental disability despite pyridoxine treatment. Adjunct lysine reduction therapies (LRT), aimed at lowering putative neurotoxic metabolites, are associated with improved cognitive outcomes. However, possibly due to timing of treatment, not all patients have normal intellectual function.

METHODS: This retrospective, multi-center cohort study evaluated the effect of timing of pyridoxine monotherapy and pyridoxine with adjunct LRT on neurodevelopmental outcome. Patients with confirmed PDE-ALDH7A1 with at least one sibling with PDE-ALDH7A1 and a difference in age at treatment initiation were eligible and identified via the international PDE registry, resulting in thirty-seven patients of 18 families. Treatment regimen was pyridoxine monotherapy in ten families and pyridoxine with adjunct LRT in the other eight. Primary endpoints were standardized and clinically assessed neurodevelopmental outcomes. Clinical neurodevelopmental status was subjectively assessed over seven domains: overall neurodevelopment, speech/language, cognition, fine and gross motor skills, activities of daily living and behavioral/psychiatric abnormalities.

RESULTS: The majority of early treated siblings on pyridoxine monotherapy performed better than their late treated siblings on the clinically assessed domain of fine motor skills. For siblings on pyridoxine and adjunct LRT, the majority of early treated siblings performed better on clinically assessed overall neurodevelopment, cognition, and behavior/psychiatry. Fourteen percent of the total cohort was assessed as normal on all domains.

CONCLUSION: Early treatment with pyridoxine and adjunct LRT may be beneficial for neurodevelopmental outcome. When evaluating a more extensive neurodevelopmental assessment, the actual impairment rate may be higher than the 75% reported in literature.

TAKE- HOME MESSAGE: Early initiation of lysine reduction therapies adjunct to pyridoxine treatment in patients with PDE-ALDH7A1 may result in an improved neurodevelopmental outcome.

Original languageEnglish
JournalMolecular Genetics and Metabolism
Volume135
Issue number4
Pages (from-to)350-356
Number of pages7
ISSN1096-7192
DOIs
Publication statusPublished - Apr 2022

Bibliographical note

Copyright © 2022. Published by Elsevier Inc.

    Research areas

  • Activities of Daily Living, Cohort Studies, Epilepsy, Humans, Lysine, Pyridoxine/therapeutic use, Retrospective Studies

ID: 79733954