Long-term neurodevelopmental effects of early detection and treatment in a 6-year-old patient with argininaemia diagnosed by newborn screening
Summary Newborn screening makes possible the early identification and treatment of asymptomatic ARG1-deficient patients; however, it is unknown whether early intervention prevents neurological insults. We identified a full-term Hispanic male infant with argininaemia by newborn screening with a serum...
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Published in | Journal of inherited metabolic disease Vol. 32; no. Suppl 1; pp. 197 - 200 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Dordrecht
Springer Netherlands
01.12.2009
Blackwell Publishing Ltd |
Subjects | |
Online Access | Get full text |
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Summary: | Summary
Newborn screening makes possible the early identification and treatment of asymptomatic ARG1-deficient patients; however, it is unknown whether early intervention prevents neurological insults. We identified a full-term Hispanic male infant with argininaemia by newborn screening with a serum arginine of 327 µmol/L (reference values 0–140); ARG1 was undetectable on enzyme assay. Sequence analysis of
ARG1
revealed a heterozygous nonsense mutation, c.223A>T (p.K75X), and a novel heterozygous missense variant, c.425G>A (p.G142E). Dietary protein restriction began from age 3 months, with addition of sodium benzoate at 4 months, and carnitine from 14 months. For the past 6 years, his serum arginine concentrations were maintained between 268 and 763 µmol/L (reference values 10–140). He has normal development without spastic paraplegia, but with mild hepatomegaly and stable hepatic dysfunction. A full neurodevelopmental assessment was conducted at age 5 years. The BASC-2 rated the patient’s behaviours as age-appropriate. The Leiter-R assessed his ‘Fundamental Visualization’, ‘Sequential Order’, and ‘Picture Concept’ at ‘Average’, ‘Form Completion’ and ‘Matching’ at ‘Low Average’, and ‘Figure Ground’ and ‘Repeated Patterns’ in the ‘Deficit’ range. The full-scale IQ and the functioning ability presented in the ‘Borderline’ range and in the ‘Low Average’ range, respectively. The VABS/Survey – Spanish Version showed difficulty in receptive and written language and fine and gross motor skills, and his performance to be at younger than his chronological age. The Short Sensory Profile showed some difficulty with taste and smell sensitivity. Long-term observation over 6 years in a patient with early treated argininaemia shows promising neurodevelopmental results. |
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Bibliography: | References to electronic databases Argininaemia (ARG1 deficiency): OMIM 207800. Arginase 1 (ARG1): EC 3.5.3.1. Communicating editor: Bruce Barshop Competing interests: None declared ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3 |
ISSN: | 0141-8955 1573-2665 |
DOI: | 10.1007/s10545-009-1148-2 |