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Aromatic l-amino acid decarboxylase deficiency in Taiwan

  • Hsiu-Fen Lee
    Affiliations
    Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC

    Institute of Biochemistry and Biotechnology, College of Medicine, Chung-Shan Medical University, Taichung, Taiwan, ROC
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  • Chi-Ren Tsai
    Affiliations
    Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan, ROC

    Institute of Molecular Biology, National Chung Hsing University, Taichung, Taiwan, ROC
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  • Ching-Shiang Chi
    Correspondence
    Corresponding author. Tungs' Taichung Metroharbor Hospital, No. 699, Sec. 1, Chungchi Road, Wuchi, Taichung 435, Taiwan, ROC. Tel.: +886 4 2658 1919; fax: +886 4 2658 1155.
    Affiliations
    Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan, ROC

    Institute of Biochemistry and Biotechnology, College of Medicine, Chung-Shan Medical University, Taichung, Taiwan, ROC
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  • Tung-Ming Chang
    Affiliations
    Department of Pediatric Neurology, Changhua Christian Hospital, Changhua, Taiwan, ROC
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  • Huei-Jane Lee
    Affiliations
    Institute of Biochemistry and Biotechnology, College of Medicine, Chung-Shan Medical University, Taichung, Taiwan, ROC
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      Abstract

      Background

      Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare autosomal recessive disorder of neurotransmitter synthesis. It has unique clinical presentations.

      Aims

      The purpose of this study is to delineate the clinical features and molecular spectrum of AADC deficiency in Taiwanese infants and children.

      Methods

      We report eight patients with characteristic clinical manifestations of AADC deficiency. Clinical presentations, treatment response, outcome and mutations of DOPA decarboxylase (DDC) gene were analyzed.

      Results

      The clinical manifestations were similar to those previously reported, including symptoms onset before age 1 year with features of severe floppiness, oculogyric crises, athetoid movement, prominent startle response, tongue thrusting, ptosis, paroxysmal diaphoresis, nasal congestion, diarrhea, irritability and sleep disorders. In addition, we observed that all patients (100.0%) had small hands and feet. During the period of follow-up, all of them (100.0%) presented severe floppiness in spite of therapeutic trials with vitamin B6, dopamine agonist, MAO inhibitor and/or anticholinergics. Three different mutations were identified in the DDC gene, including two novel mutations 1303 C>T and 1367ins A and one IVS 6+4 A>T mutation. The IVS 6+4 A>T was a splicing mutation, which inserted an additional 37 nt of intron 6 into the DDC mRNA. Thirteen out of 16 alleles (81.3%) carried IVS 6+4 A>T mutation and the IVS 6+4 A>T alleles shared a conserved haplotype.

      Conclusions

      Patients with AADC deficiency in Taiwan have particular clinical manifestations of small hands and feet, which have rarely been mentioned in the literature. The prevalence of IVS 6+4 A>T splicing mutation is high in our study group and the IVS 6+4 A>T mutation might have a founder effect.

      Keywords

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