Pyridoxine-dependent epilepsy

General Information (adopted from Orphanet):

Synonyms, Signs: PYRIDOXINE DEPENDENCY WITH SEIZURES
AASA DEHYDROGENASE DEFICIENCY
PYRIDOXINE-DEPENDENT EPILEPSY
PDE
EPD
Vitamin B6-responsive seizures
Glutamate decarboxylase deficiency
Pyridoxine-responsive seizures
Number of Symptoms 27
OrphanetNr: 3006
OMIM Id: 266100
ICD-10: G40.8
UMLs: C1291560
C1849508
MeSH: C536254
MedDRA:
Snomed: 124596009

Prevalence, inheritance and age of onset:

Prevalence: 0.2 [Orphanet]
Inheritance: Autosomal recessive
[Orphanet]
Age of onset: Neonatal
Infancy
[Orphanet]

Disease classification (adopted from Orphanet):

Parent Diseases: Disorder of pyridoxine metabolism
 -Rare genetic disease
Metabolic neurotransmission anomaly with epilepsy
 -Rare neurologic disease
Neurometabolic disease
 -Rare genetic disease
 -Rare neurologic disease

Symptom Information: Sort by abundance 

1
(HPO:0000486) Strabismus Occasional [Orphanet] 576 / 7739
2
(HPO:0100022) Abnormality of movement Very frequent [Orphanet] 129 / 7739
3
(HPO:0002353) EEG abnormality Very frequent [Orphanet] 188 / 7739
4
(HPO:0001263) Global developmental delay 853 / 7739
5
(HPO:0002133) Status epilepticus 59 / 7739
6
(HPO:0002167) Neurological speech impairment Very frequent [Orphanet] 308 / 7739
7
(HPO:0001250) Seizures Very frequent [Orphanet] 1245 / 7739
8
(HPO:0000750) Delayed speech and language development 197 / 7739
9
(HPO:0001249) Intellectual disability 1089 / 7739
10
(HPO:0002123) Generalized myoclonic seizures 62 / 7739
11
(HPO:0002069) Generalized tonic-clonic seizures 96 / 7739
12
(HPO:0001557) Prenatal movement abnormality 16 / 7739
13
(HPO:0002240) Hepatomegaly Occasional [Orphanet] 467 / 7739
14
(HPO:0001939) Abnormality of metabolism/homeostasis Very frequent [Orphanet] 328 / 7739
15
(HPO:0002098) Respiratory distress 75 / 7739
16
(HPO:0002643) Neonatal respiratory distress 22 / 7739
17
(HPO:0001324) Muscle weakness 859 / 7739
18
(HPO:0008947) Infantile muscular hypotonia 482 / 7739
19
(HPO:0010547) Muscle flaccidity 466 / 7739
20
(HPO:0001252) Muscular hypotonia Frequent [Orphanet] 990 / 7739
21
(HPO:0002120) Cerebral cortical atrophy Occasional [Orphanet] 187 / 7739
22
(OMIM) Increased serum and cerebrospinal fluid levels of pipecolic acid 1 / 7739
23
(OMIM) Increased serum, cerebrospinal fluid, and urinary levels of alpha-aminoadipic semialdehyde 1 / 7739
24
(OMIM) Fetal distress 4 / 7739
25
(HPO:0012758) Neurodevelopmental delay Very frequent [Orphanet] 949 / 7739
26
(HPO:0000007) Autosomal recessive inheritance 2538 / 7739
27
(HPO:0002119) Ventriculomegaly Occasional [Orphanet] 253 / 7739

Associated genes:

ClinVar (via SNiPA)

Gene symbol Variation Clinical significance Reference

Additional Information:

Description: (OMIM) Pyridoxine-dependent epilepsy, characterized by a combination of various seizure types, usually occurs in the first hours of life and is unresponsive to standard anticonvulsants, responding only to immediate administration of pyridoxine hydrochloride. The dependence is permanent, and the ...
Diagnosis OMIM Plecko et al. (2007) noted that in pyridoxine-dependent epilepsy, pipecolic acid (PA) and alpha-amino adipic semialdehyde (AASA) are markedly elevated in urine, plasma, and cerebrospinal fluid, and thus can be used as biomarkers of the disorder. Pyridoxine withdrawal ...
Clinical Description OMIM Pyridoxine-dependent epilepsy was first described by Hunt et al. (1954). Waldinger (1964) described 3 sibs of Italian ancestry in whom pyridoxine dependency was manifest by convulsions at birth. Four previously reported sibships with more than 1 affected sib ...
Molecular genetics OMIM In affected infants from 8 unrelated families with pyridoxine-dependent epilepsy. Mills et al. (2006) identified homozygous or compound heterozygous mutations in the ALDH7A1 gene (107323.0001-107323.0007).

In 7 patients from 4 apparently unrelated Dutch families with pyridoxine-dependent ...

Population genetics OMIM Bok et al. (2007) estimated the incidence of pyridoxine-dependent seizures in the Netherlands to be 1 in 276,000.
Diagnosis GeneReviews As recommended by Goutières & Aicardi [1985], pyridoxine dependency should be considered as the cause of intractable seizures in the following situations: ...
Clinical Description GeneReviews The one clinical feature characteristic of all individuals with pyridoxine-dependent epilepsy is intractable seizures that are not controlled with antiepileptic medications but that respond both clinically and electrographically to large daily supplements of pyridoxine. ...
Genotype-Phenotype Correlations GeneReviews More than 60 ALDH7A1 sequence alterations have been documented in both neonatal-onset and late-onset cases; however, no firm genotype-phenotype correlations are known [Mills et al 2006, Kanno et al 2007, Plecko et al 2007, Rankin et al 2007, Salomons et al 2007, Bennett et al 2009, Striano et al 2009, Mills et al 2010, Scharer et al 2010, Stockler et al 2011]. ...
Differential Diagnosis GeneReviews Pyridoxine-dependent epilepsy should be considered as a cause of intractable seizures presenting in neonates, infants, and children up to the third year of life for which an underlying lesion (i.e., symptomatic epilepsy) has not been identified. ...
Management GeneReviews To establish the extent of disease in an individual diagnosed with pyridoxine-dependent epilepsy, developmental assessment is appropriate....
Molecular genetics GeneReviews Information in the Molecular Genetics and OMIM tables may differ from that elsewhere in the GeneReview: tables may contain more recent information. —ED....