Presentation
We present the clinical course and EEG evolution of an extreme low birth weight preterm neonate with an uncommon type of glycine encephalopathy. [ncbi.nlm.nih.gov]
The pathology presents encephalopathy in the neonatal period (85% as the neonatal severe form and 15% as the neonatal mild form). Of those cases presenting in infancy, 50% have the infantile mild form and 50% have the infantile severe form. [genetaq.com]
The first patient was a 5-day-old girl, born to first cousin parents, who presented with a weak cry, progressive lethargy, poor feeding and hiccough for three days. [cags.org.ae]
Initially, these patients present with the same symptoms and laboratory results that are seen in the classical presentation. [en.wikipedia.org]
Infantile form presents with history of hypotonia, developmental delay, and seizures. [pediatricneurosciences.com]
Entire Body System
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Poor Feeding
feeding, lack of energy (lethargy), weak muscle tone ( hypotonia ), hiccups, breathing problems, seizures, hiccups, and coma. [rarediseases.info.nih.gov]
At 4-days of age she had poor feeding and lethargy. At 1-month of age she developed seizures. Brain MRI showed agenesis of the corpus callosum. [cags.org.ae]
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Cerebral Palsy
94 Paroxysmal Dyskinesias E-1637 95 Movement Disorders of Infancy E-1646 96 DrugInduced Movement Disorders in Children E-1651 97 Cerebral Palsy E-1660 98 Tics and Tourette Syndrome E-1673 99 Genetic and Metabolic Disorders of the White Matter E-1690 100 [books.google.com]
Workup
Other NMS-mimicking conditions, including nonconvulsive status epilepticus, malignant catatonia, serotonin syndrome and intracranial infections, were also considered and excluded during the patient’s initial workup before the diagnosis of NMS was made [e-jmd.org]
X-Ray
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Posterior Fossa Cysts
GCS enzyme activity can also be measured in liver biopsy. [10] Brain malformations such as agenesis of corpus callosum, gyral malformation, posterior fossa cysts, and ventricular enlargement may be evident in MRI brain. [11], [12] Vacuolating myelinopathy [pediatricneurosciences.com]
EEG
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Spike-and-Slow-Waves
Seven patients had seizures with generalized spike and slow wave abnormalities in EEG; 2 had infantile spasms with hypsarrhythmia. All had delayed motor development, moderate mental retardation, and limited expressive language. [cags.org.ae]
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Hypsarrhythmia
Seven patients had seizures with generalized spike and slow wave abnormalities in EEG; 2 had infantile spasms with hypsarrhythmia. All had delayed motor development, moderate mental retardation, and limited expressive language. [cags.org.ae]
Microbiology
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Helicobacter Pylori
Pediatr Res 1982;16:57.[18] Ohara H, Suzuki T, Nakagawa T, Yoneshima M, Yamamoto M,Tsujino D, et al. 13C-UBT using an infrared spectrometer fordetection of Helicobacter pylori and for monitoring the eects oflansoprazole. [documents.tips]
Ohara H, Suzuki T, Nakagawa T, et al. 13C-UBT using aninfrared spectrometer for detection of Helicobacter pylori andfor monitoring the effects of lansoprazole. J Clin Gastroenterol1995;20(suppl 2):S115S117.18. Korman SH, Boneh A, Ichinohe A, et al. [docslide.com.br]
Biopsy
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Liver Biopsy
It is currently problematic to confirm the clinical diagnosis of glycine encephalopathy, requiring either invasive liver biopsy for enzymatic analysis of the glycine cleavage system or exhaustive mutation analysis. [ncbi.nlm.nih.gov]
biopsy for enzymatic analysis of the glycine cleavage system or exhaustive mutation analysis. [doi.org]
Her parents gave consent forthe breath test, but not for the liver biopsy. [docslide.com.br]
GCS enzyme activity can also be measured in liver biopsy. [10] Brain malformations such as agenesis of corpus callosum, gyral malformation, posterior fossa cysts, and ventricular enlargement may be evident in MRI brain. [11], [12] Vacuolating myelinopathy [pediatricneurosciences.com]
Treatment
Studies regarding the effectiveness of these treatments are ongoing. Mildly affected individuals may receive the greatest benefit from treatment, particularly if treatment is started early. [xpertdox.com]
Evaluation of relatives at risk: Testing of at-risk sibs to promote early diagnosis and treatment. GENETIC COUNSELING: Glycine encephalopathy is inherited in an autosomal recessive manner. [ncbi.nlm.nih.gov]
CLOSE Medical Disclaimer The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. [diseaseinfosearch.org]
The suspected cause of transient neonatal hyperglicinemia is attributed to low activity of the glycine cleavage system in the immature brain and liver of the neonate. [3] Treatment [ edit ] A treatment of sodium benzoate, which binds to glycine and forms [en.wikipedia.org]
In one convenient source, this book provides a broad, detailed, and cohesive overview of seizure disorders and contemporary treatment options. [books.google.de]
Prognosis
Biochemical and molecular predictors for prognosis in nonketotic hyperglycinemia. Ann Neurol. 2015 Oct;78(4):606-18. doi: 10.1002/ana.24485. Epub 2015 Aug 10. [rarediseases.org]
[ edit ] The prognosis is very poor. [en.wikipedia.org]
Atypical cases present late in childhood with spastic diplegia, ataxia, and optic atrophy. [5] Only 20% of the cases carry good prognosis although they suffer from minimal developmental delay. [6] The illness may be precipitated by fever or high protein [pediatricneurosciences.com]
Van Hove JLK, Mahieu V, Schollen E (2004) Prognosis in nonketotic hyperglycinemia. J Inherit Metab Dis 26:71 Google Scholar 29. Kure S, Narisawa K, Tada K (1992) Enzymatic diagnosis of non ketotic hyperglycinemia with lymphoblasts. [link.springer.com]
Etiology
Typical result of theMLPA analysis in the GE patients is shown in Fig. 3.Sequencing analysis of the anking sequences of severaldeletions suggested that Alu-mediated recombinationmay underlie in the etiology of the GLDC deletions.3.4. [documents.tips]
Epidemiology
To provide a basis for improving the understanding of the epidemiology, genotype/phenotype correlation and outcome of these diseases their impact on the quality of life of patients, and for evaluating diagnostic and therapeutic strategies a patient registry [en.wikipedia.org]
Relevant External Links for GLDC Genetic Association Database (GAD) GLDC Human Genome Epidemiology (HuGE) Navigator GLDC Atlas of Genetics and Cytogenetics in Oncology and Haematology: GLDC No data available for Genatlas for GLDC Gene The glycine cleavage [genecards.org]
Causes Differentiating D-Glyceric acidemia from Other Diseases Epidemiology and Demographics Risk Factors Screening Natural History, Complications, and Prognosis Diagnosis Diagnostic Criteria History and Symptoms Physical Examination Laboratory Findings [wikidoc.org]
Pathophysiology
Carriers usually do not show signs or symptoms of the disorder. [2] Pathophysiology [ edit ] Glycine is the simplest amino acid, having no stereoisomers. [en.wikipedia.org]
Physiological and pathophysiological roles of excitatory amino acids during central nervous system development. Brain Res Brain Res Rev 1990;15:41-70. 5. Hennermann JB. Clinical variability in glycine encephalopathy. Future Neurol 2006;1:621-30. 6. [pediatricneurosciences.com]
Tada K, Kure S (1993) Non-ketotic hyperglycinaemia: molecular lesion, diagnosis and pathophysiology. J Inherit Metab Dis 16:691–703 PubMed CrossRef Google Scholar 2. [link.springer.com]
[…] an apparently asymptomatic period of months or even years with various symptoms such as mental retardation, episodes of chorea, vertical gaze palsy and delirium, or progressive spastic diplegia and optic atrophy. 2, 3 Metabolic Derangement, Including Pathophysiology [mhmedical.com]
Pathophysiology Genetics D-Glyceric acidemia has an autosomal recessive pattern of inheritance. Mutations in the AMT and GLDC genes cause glycine encephalopathy. [wikidoc.org]
Prevention
Mutations in any of these genes prevent the complex decomposes glycine correctly, which can lead to accumulation of glycine to toxic concentrations in the organs and tissues. [ivami.com]
Prevention of secondary complications: For those on sodium benzoate, monitor plasma carnitine concentration and supplement with carnitine as needed. [ncbi.nlm.nih.gov]
Defects in the GSC proteins can prevent the complex from functioning properly or can prevent the GCS complex from forming entirely. [en.wikipedia.org]
Mutations in either the AMT or GLDC gene prevent the complex from breaking down glycine properly. When glycine cleavage enzyme is defective, excess glycine can build up to toxic levels in the body's organs and tissues. [ghr.nlm.nih.gov]
Though sodium benzoate reduces plasma glycine concentration and prevents seizures, it requires careful monitoring of glycine levels, benzoate levels and carnitine levels. NMDA antagonists require vigilant observation as well. [pediatricneurosciences.com]