pmc logo imageJournal ListSearchpmc logo image
Logo of jnnpsycJournal URL: redirect3.cgi?&&auth=00atb6jbHhWTp5mZ5T7cR77SEHP8fTiklyb39DAnW&reftype=publisher&artid=489075&article-id=489075&iid=15576&issue-id=15576&jid=171&journal-id=171&FROM=Article|Banner&TO=Publisher|Other|N%2FA&rendering-type=normal&&http://jnnp.bmj.com/
J Neurol Neurosurg Psychiatry. 1992 May; 55(5): 359–361.
PMCID: PMC489075
Spasticity and white matter abnormalities in adult phenylketonuria.
P A McCombe, D B McLaughlin, J B Chalk, N N Brown, J J McGill, and M P Pender
Department of Medicine, University of Queensland, Brisbane, Australia.
Abstract
A 19 year old male with phenylketonuria (PKU) developed a spastic paparesis 8 months after stopping his restricted phenylalanine diet. CT and MRI showed abnormalities of the deep cerebral white matter, and visual evoked response latencies were prolonged. The spasticity gradually improved over several months after resuming the PKU diet. A repeat MRI scan was unchanged. His brother also had PKU and ceased dietary restrictions, but his only neurological abnormality was a slight increase in the deep tendon reflexes of the lower limbs. CT and MRI of his brain was normal. DNA analysis showed that both brothers were homozygous for the same PKU mutation. These patients demonstrate that reversible neurological signs may develop in patients with classic PKU after ceasing dietary restrictions and that these may be associated with abnormalities seen on neuro-imaging.
Full text
Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (892K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.
Images in this article
Click on the image to see a larger version.
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
  • Pedersen, HE; Birket-Smith, E. Neurological abnormalities in phenylketonuria. Acta Neurol Scand. 1974;50(5):589–598. [PubMed]
  • Malamud, N. Neuropathology of phenylketonuria. J Neuropathol Exp Neurol. 1966 Apr;25(2):254–268. [PubMed]
  • Thompson, AJ; Smith, I; Brenton, D; Youl, BD; Rylance, G; Davidson, DC; Kendall, B; Lees, AJ. Neurological deterioration in young adults with phenylketonuria. Lancet. 1990 Sep 8;336(8715):602–605. [PubMed]
  • Lou, HC; Güttler, F; Lykkelund, C; Bruhn, P; Niederwieser, A. Decreased vigilance and neurotransmitter synthesis after discontinuation of dietary treatment for phenylketonuria in adolescents. Eur J Pediatr. 1985 May;144(1):17–20. [PubMed]
  • DiLella, AG; Huang, WM; Woo, SL. Screening for phenylketonuria mutations by DNA amplification with the polymerase chain reaction. Lancet. 1988 Mar 5;1(8584):497–499. [PubMed]
  • Güttler, F; Ledley, FD; Lidsky, AS; DiLella, AG; Sullivan, SE; Woo, SL. Correlation between polymorphic DNA haplotypes at phenylalanine hydroxylase locus and clinical phenotypes of phenylketonuria. J Pediatr. 1987 Jan;110(1):68–71. [PubMed]
  • NEAME, KD. Phenylalanine as inhibitor of transport of amino-acids in brain. Nature. 1961 Oct 14;192:173–174. [PubMed]
  • CROME, L; TYMMS, V; WOOLF, LI. A chemical investigation of the defects of myelination in phenylketonuria. J Neurol Neurosurg Psychiatry. 1962 May;25:143–148. [PubMed]
  • Williamson, ML; Koch, R; Azen, C; Chang, C. Correlates of intelligence test results in treated phenylketonuric children. Pediatrics. 1981 Aug;68(2):161–167. [PubMed]
  • Giovannini, M; Valsasina, R; Villani, R; Ducati, A; Riva, E; Landi, A; Longhi, R. Pattern reversal visual evoked potentials in phenylketonuria. J Inherit Metab Dis. 1988;11(4):416–421. [PubMed]
  • Wood, B. Neurological disturbance in a phenylketonic child after discontinuation of dietary treatment. Dev Med Child Neurol. 1976 Oct;18(5):657–660. [PubMed]
  • Villasana, D; Butler, IJ; Williams, JC; Roongta, SM. Neurological deterioration in adult phenylketonuria. J Inherit Metab Dis. 1989;12(4):451–457. [PubMed]
  • McKean, CM. The effects of high phenylalanine concentrations on serotonin and catecholamine metabolism in the human brain. Brain Res. 1972 Dec 12;47(2):469–476. [PubMed]
  • Butler, IJ; O'Flynn, ME; Seifert, WE, Jr; Howell, RR. Neurotransmitter defects and treatment of disorders of hyperphenylalaninemia. J Pediatr. 1981 May;98(5):729–733. [PubMed]
  • TASHIAN, RE. Inhibition of brain glutamic acid decarboxylase by phenylalanine, valine, and leucine derivatives: a suggestion concerning the etiology of the neurological defect in phenylketonuria and branched-chain ketonuria. Metabolism. 1961 May;10:393–402. [PubMed]
  • Lykkelund, C; Nielsen, JB; Lou, HC; Rasmussen, V; Gerdes, AM; Christensen, E; Güttler, F. Increased neurotransmitter biosynthesis in phenylketonuria induced by phenylalanine restriction or by supplementation of unrestricted diet with large amounts of tyrosine. Eur J Pediatr. 1988 Dec;148(3):238–245. [PubMed]