Practical management of combined methylmalonicaciduria and homocystinuria

Debra L. Smith, Olaf A. Bodamer

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Combined methylmalonicaciduria and homocystinuria is a disorder of intracellular cobalamin metabolism that remains a challenge to the physician unfamiliar with the diagnosis. We have followed six patients with combined methylmalonic-aciduria and homocystinuria (four males, two females, age 4.2-24 years) for a median of 6.5 years (range 4-9 years). Age at diagnosis was between 18 days and 14 months in early-onset cases (n = 4) and 15 and 19 years in late-onset cases. Predominant clinical features include microcephaly, hydrocephalus, seizures, and white-matter changes on magnetic resonance imaging in early-onset cases. The white-matter changes may be secondary to impaired methylation owing to a lack of readily available methyl groups. Spastic quadriparesis and diplegia are long-term sequelae in late-onset cases. Management consists of hydroxycobalamin intramuscular injections, oral folate, betaine, and carnitine supplementation. Dietary protein restriction may be necessary when metabolic control remains difficult. The implementation of an emergency regimen should alleviate episodes of metabolic decompensation and reduce the rate of hospital admissions.

Original languageEnglish
Pages (from-to)353-356
Number of pages4
JournalJournal of Child Neurology
Volume17
Issue number5
StatePublished - May 1 2002

Fingerprint

Homocystinuria
Hydroxocobalamin
Betaine
Microcephaly
Quadriplegia
Dietary Proteins
Carnitine
Intramuscular Injections
Cerebral Palsy
Vitamin B 12
Hydrocephalus
Folic Acid
Methylation
Seizures
Emergencies
Magnetic Resonance Imaging
Physicians
White Matter
Methylmalonic acidemia

ASJC Scopus subject areas

  • Clinical Neurology
  • Pediatrics, Perinatology, and Child Health

Cite this

Practical management of combined methylmalonicaciduria and homocystinuria. / Smith, Debra L.; Bodamer, Olaf A.

In: Journal of Child Neurology, Vol. 17, No. 5, 01.05.2002, p. 353-356.

Research output: Contribution to journalArticle

Smith, Debra L. ; Bodamer, Olaf A. / Practical management of combined methylmalonicaciduria and homocystinuria. In: Journal of Child Neurology. 2002 ; Vol. 17, No. 5. pp. 353-356.
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