Natural history, outcome, and treatment efficacy in children and adults with glutaryl-CoA dehydrogenase deficiency

Stefan Kölker, Sven F. Garbade, Cheryl R. Greenberg, James V. Leonard, Jean Marie Saudubray, Antonia Ribes, H. Serap Kalkanoglu, Allan M. Lund, Begoña Merinero, Moacir Wajner, Mónica Troncoso, Monique Williams, John H. Walter, Jaume Campistol, Milagros Martí-Herrero, Melissa Caswill, Alberto B. Burlina, Florian Lagler, Esther M. Maier, Bernd SchwahnAysegul Tokatli, Ali Dursun, Turgay Coskun, Ronald A. Chalmers, David M. Koeller, Johannes Zschocke, Ernst Christensen, Peter Burgard, Georg F. Hoffmann

Research output: Contribution to journalArticlepeer-review

166 Scopus citations

Abstract

Glutaryl-CoA dehydrogenase (GCDH) deficiency is a rare inborn disorder of l-lysine, l-hydroxylysine, and l-tryptophan metabolism complicated by striatal damage during acute encephalopathic crises. Three decades after its description, the natural history and how to treat this disorder are still incompletely understood. To study which variables influenced the outcome, we conducted an international cross-sectional study in 35 metabolic centers. Our main outcome measures were onset and neurologic sequelae of acute encephalopathic crises. A total of 279 patients (160 male, 119 female) were included who were diagnosed clinically after clinical presentation (n = 218) or presymptomatically by neonatal screening (n = 23), high-risk screening (n = 24), or macrocephaly (n = 14). Most symptomatic patients (n = 185) had encephalopathic crises, characteristically resulting in bilateral striatal damage and dystonia, secondary complications, and reduced life expectancy. First crises usually occurred during infancy (95% by age 2 y); the oldest age at which a repeat crisis was reported was 70 mo. In a few patients, neurologic disease developed without a reported crisis. Differences in the diagnostic criteria and therapeutic protocols for patients with GCDH deficiency resulted in a huge variability in the outcome worldwide. Recursive partitioning demonstrated that timely diagnosis in neurologically asymptomatic patients followed by treatment with l-carnitine and a lysine-restricted diet was the best predictor of good outcome, whereas treatment efficacy was low in patients diagnosed after the onset of neurologic disease. Notably, the biochemical phenotype did not predict the clinical phenotype. Our study proves GCDH deficiency to be a treatable disorder and a good candidate for neonatal screening.

Original languageEnglish (US)
Pages (from-to)840-847
Number of pages8
JournalPediatric Research
Volume59
Issue number6
DOIs
StatePublished - Jun 2006

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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