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Journal of Pediatric Epilepsy 2019; 08(02): 049-055
DOI: 10.1055/s-0039-1697676
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Pyridox(am)ine 5′-Phosphate Oxidase Deficiency: Severe Prenatal Presentation with Hypoxic Ischemic Encephalopathy

Malak Alghamdi
1   Division of Medical Genetics, Department of Pediatrics, King Saud University, College of Medicine, Riyadh, Saudi Arabia
,
Stefan T. Arold
2   Division of Biological and Environmental Science and Engineering, Computational Bioscience Research Centre, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
,
Hamdi Hasan
3   Division of Neuroradiology, Department of Radiology, King Saud University, College of Medicine, Riyadh, Saudi Arabia
,
Fahad Bashiri
4   Division of Neurology, Department of Pediatrics, King Saud University, College of Medicine, Riyadh, Saudi Arabia
› Author Affiliations Funding This work was supported by the College of Medicine Research Center, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia; Dallah Health Grant. The research by STA reported in this publication was supported by funding from King Abdullah University of Science and Technology (KAUST), Office of Sponsored Research (OSR), under award number FCC/1/1976-25.
Further Information

Publication History

06 July 2019

21 August 2019

Publication Date:
10 October 2019 (online)

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Abstract

Pyridox(am)ine 5′-phosphate oxidase (PNPO) deficiency is a rare autosomal recessive vitamin-responsive epileptic encephalopathy that manifests with a clinically and electrographically observable antiepileptic response to pyridoxine or pyridoxal 5′-phosphate (P5P). We report a preterm infant who presented with fetal distress and hypoxic ischemic encephalopathy (HIE) as well as seizures that responded to pyridoxine in the first day of life. The patient was diagnosed with PNPO deficiency and homozygosity for a missense-mutation in exon 7 of the PNPO gene, c.673 c > T (Arg225Cys), which disrupts the P5P binding site on PNPO. P5P with folinic acid achieved good control of the seizures. Riboflavin was introduced in the second year of life. The patient continued to have episodes of breakthrough seizures with sickness. P5P therapy resulted in marked seizure cessation but did not improve neurocognitive function in this patient, who had significant global psychomotor delay at the age of 3 years despite early treatment. We conclude from this report and other reports that HIE is a co-occurring condition with some inborn errors of metabolism. Therefore, PNPO deficiency should be investigated and P5P trial should be considered in case of presumed HIE particularly with familial recurrence of epileptic encephalopathy and refractory seizure.

Keywords

pyridox(am)ine-5-phosphate oxidase - neonatal hypoxic ischemic encephalopathy - inborn error of metabolism
 

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