Dirençli Epilepsinin Tedavi Edilebilir Bir Nedeni: Piridoksin Bağımlı Epilepsi

Yıl 2020, Cilt: 14 Sayı: 6, 461 - 464, 30.11.2020

Hepsen Mine Serin , Sanem Yılmaz Erdem Şimşek Seda Kanmaz Ayça Aykut , Asude Durmaz Gül Aktan , Hasan Tekgül Sarenur Gökben

https://doi.org/10.12956/tchd.568456

Öz

Amaç: Piridoksin bağımlı epilepsi, tipik olarak bebeklik veya
erken çocukluk döneminde inatçı nöbetler ile seyreden nadir görülen otozomal
resesif bir hastalıktır. Nöbetler geleneksel antiepileptik tedavilere dirençli
olup, farmakolojik dozda piridoksine yanıt verir. Bu çalışmada PBE tanısı ile 
izlediğimiz altı hastanın klinik ve genetik özelliklerini  sunmayı amaçladık.

Gereç ve Yöntemler: Ege Üniversitesi Tıp Fakültesi Çocuk Nöroloji Bilim
Dalı’nda  Piridoksin bağımlı epilepsi tanısı ile izlenen altı
olgunun klinik ve genetik özellikleri ile prognozu retrospektif olarak
değerlendirildi.

Bulgular: Çalışmaya alınan hastaların 5’i erkek, 1’i kız olup, yaş
ortalaması 6,83±3,71 yıl idi. Nöbet başlangıç yaşı ortalama 22,33± 31,77
(3-90gün) olup, bir hasta (n:4) hariç diğerleri yenidoğan döneminde başlamıştı.
Üç hastada fokal motor nöbet, 2 hastada jeneralize motor nöbet ve 1 hastada epileptik
spazm  izlendi. Hastaların vitamin B6
tedavisi bir hasta hariç erken dönemde başlandı. Erken dönem tedavi başlanan
bir hasta dışında diğer hastalarda mental retardasyon, stereotipik hareketler
ve otistik bulgular izlendi. Yapılan moleküler genetik analizde 5 farklı
mutasyon saptanmıştır [2 olguda homozigot c.1597delG (p.Ala533ProfsTer18), 1
olguda homozigot c.781 A>G (p.Met261Val), 1 olguda birleşik heterozigot
c.328C>T (p.Arg110Ter)/c.1566-1G>T, 1 olguda heterozigot c.328C>T
(p.Arg110Ter) ve 1 olguda heterozigot c.1356 A>C (p.Lys452Asn)] .

Sonuç: PBE tedavi edilebilir epilepsi nedenlerinden biri olup
açıklanamayan dirençli nöbetleri olan bebeklerde  mutlaka düşünülmeli ve terapotik dozda
piridoksin tedavisine başlanmalıdır.

Anahtar Kelimeler

Piridoksin bağımlı epilepsi, ALDH7A1, nöbet

Destekleyen Kurum

yok

A Treatable Cause of Refractory Epilepsy: Pyridoxine-Dependent Epilepsy

Öz

Objective: Pyridoxine-dependent epilepsy (PDE) is a rare autosomal recessive disorder that typically presents with refractory seizures in infancy or early childhood. Seizures are resistant to conventional antiepileptic treatments and responsive to pharmacologic doses of pyridoxine. In this study, we aimed to present the clinical and genetic features of
six patients followed up in our clinic with PDE diagnosis.
Material and Methods: Pyridoxine-dependent epilepsy (PDE) is a rare autosomal recessive disorder that typically presents with refractory seizures in infancy or early childhood. Seizures are resistant to conventional antiepileptic treatments and responsive to pharmacologic doses of pyridoxine. In this study, we aimed to present the clinical and
genetic features of six patients followed up in our clinic with PDE diagnosis.
Results: Among six patients five were male and one was female. Mean age was 6.83 ± 3.71 years. The mean age of onset for seizures was 22.33 ± 31.77 (3-90 days). Seizures had started in the newborn period in all patients except one patient (n: 4). Three patients had focal motor seizures, 2 patients had generalized motor seizures and 1 patient had epileptic spasms. Vitamin B6 therapy was started in the early period except one patient. Mental retardation, stereotypic movements and autistic findings were observed in the all patients except one patient who had received early treatment. Molecular genetic analysis revealed 5 different mutations [homozygous c.1597delG (p.Ala533ProfsTer18) in 2 cases, homozygous c.781 A> G (p.Met261Val) in 1 case, compound heterozygous c.328C> T (p.Arg110Ter) / c.1566- 1G>T, 1 case heterozygous c.328C> T (p.Arg110Ter) and 1 case heterozygous c.1356 A> C (p.Lys452Asn) ] .

Conclusion: Pyridoxine-dependent epilepsy is a treatable cause of epilepsy and should come to mind in infants with unexplained refractory seizures. Treatment with a therapeutic dose of pyridoxine should be started promptly.

Anahtar Kelimeler

Seizure, Pyridoxine-dependent epilepsy, Vitamin B6

Kaynakça

• 1-A.D. Hunt Jr., J. Stokes Jr., W.W. McCrory, H.H. Stroud, Pyridoxine dependency: report of a case of intractable convulsions in an infant controlled by pyridoxine, Pediatrics 1954;13:140–5.
• 2- P. Baxter, Pyridoxine-dependent and pyridoxine-responsive seizures, Dev. Med. Child Neurol. 2001;43:416–20.
• 3- Gospe SM Jr. Pyridoxine-dependent seizures: new genetic and biochemical clues to help with diagnosis and treatment. Curr Opin Neurol 2006;19:148-53.
• 4- Mills PB, Footitt EJ, Mills KA, Tuschl K, Aylett S, Varadkar S, et al. Genotypic and phenotypic spectrum of pyridoxine-dependent epilepsy (ALDH7A1 deficiency). Brain 2010;133:2148-59.
• 5- Mills PB, Struys E, Jakobs C, Plecko B, Baxter P, Baumgartner M, et al. Mutations in antiquitin in individuals with pyridoxine-dependent seizures. Nat Med. 2006;12:307–9
• 6- Plecko B, Paul K, Paschke E, Stoeckler-Ipsiroglu S, Struys E, Jakobs C, et al. Biochemical and molecular characterization of 18 patients with pyridoxine-dependent epilepsy and mutations of the antiquitin (ALDH7A1) gene. Hum Mutat 2007;28:19-26.
• 7-Stockler S, Plecko B, Gospe SM Jr. Pyridoxine dependent epilepsy and antiquitin deficiency: clinical and molecular characteristics and recommendations for diagnosis, treatment and follow-up. Mol Genet Metab. 2011;104:48-60.
• 8-Gordon N. Pyridoxine dependency: an update. Dev Med Child Neurol 1997;39: 63-65.
• 9-S.M. Gospe, Pyridoxine-dependent seizures: findings from recent studies pose new questions, Pediatr. Neurol. 2002;26:181–5.
• 10- R. Nabbout, C. Soufflet, P. Plouin, O. Dulac, Pyridoxine dependent epilepsy: a suggestive electroclinical pattern, Arch. Dis. Child Fetal Neonatal Ed. 1999;81:125-9.11-L. Hellstrom-Westas, G. Blennow, I. Rosen, Amplitude-integrated encephalography in pyridoxine-dependent seizures and pyridoxine-responsive seizures, Acta Paediatr. 2002;91:977–90.
• 12-Jansen LA, Hevner RF, Roden WH, Hahn SH, Jung S, Gospe SM Jr. Glial localization of antiquitin: implications for pyridoxine-dependent epilepsy. Ann Neurol 2014;75:22–32. 13-Jain-Ghai S, Mishra N, Hahn C, Blaser S, Mercimek-Mahmutoglu S.. Fetal onset ventriculo- megaly and subependymal cysts in a pyridoxine dependent epilepsy patient. Pediatrics 2014;133:e1092–6.
• 14-Perez B, Gonzalez L, Verdu A. Clinical, biomedical, and moleculer studies in pyridoxine-dependent epilepsy. Antisense therapy as possible new therapeutic option. Epilepsia 2013;54:239-48.
• 15- Cormier-Daire V, Dagoneau N, Nabbout R, Burglen L, Penet C, Soufflet C, et al. A Gene for Pyridoxine-Dependent Epilepsy Maps to Chromosome 5q31. Am. J. Hum. Genet 2000;67: 991-3.
• 16- Tlili A, Hentati N, Chaabane R. Pyridoxine-dependent epilepsy in Tunisia is caused by a founder missense mutation of ALDH7A1 gene. Gene 2013; 518: 242-5.
• 17- Mefford HC, Zemel M, Geraghty E, Cook J, Clayton PT, Paul K, et al. Intragenic deletions of ALDH7A1 in pyridoxine-dependent epilepsy caused by Alu-Alu recombination. Neurology. 2015;85:756-62.
• 18-Campistol J. Epilepsy in inborn errors of metabolism with therapeutic options. Semin Pediatr Neurol 2016;23:321-31.
• 19- Bok LA, Halbertsma FJ, Houterman S. Long-term outcome in pyridoxine-dependent epilepsy. Dev Med Child Neurol 2012;54:849-54.
• 20- Van Karnebeek CD, Jaggumantri S. Current treatment and management of pyridoxine-dependent epilepsy. Curr. Treat. Options Neurol 2015;17:335.