Infantile Serine Biosynthesis Defect Due to Phosphoglycerate Dehydrogenase Deficiency: Variability in Phenotype and Treatment Response, Novel Mutations, and Diagnostic Challenges

J Child Neurol. 2017 May;32(6):543-549. doi: 10.1177/0883073817690094. Epub 2017 Jan 31.

Abstract

Serine biosynthesis defects can present in a broad phenotypic spectrum ranging from Neu-Laxova syndrome, a lethal disease with multiple congenital anomalies at the severe end, to an infantile disease with severe psychomotor retardation and seizures as an intermediate phenotype, to a childhood disease with intellectual disability at the mild end. In this report we present 6 individuals from 3 families with infantile phosphoglycerate dehydrogenase (PGDH) deficiency who presented with psychomotor delay, growth failure, microcephaly, and spasticity. The phenotype was variable with absence of seizures in 2 sisters in family 1 and 1 infant in family 2 and seizures with pronounced happy affect in 3 sisters in family 3. The initiation of serine treatment had pronounced effect on seizures and spasticity in the sisters in family 3, but minimal developmental effects on the children in families 1 and 2. With such phenotypic variability, the diagnosis of PGDH deficiency can be challenging.

Keywords: Neu-Laxova syndrome; PGDH; microcephaly; seizures; spasticity.

Publication types

  • Case Reports

MeSH terms

  • Abnormalities, Multiple* / diagnostic imaging
  • Abnormalities, Multiple* / etiology
  • Abnormalities, Multiple* / genetics
  • Abnormalities, Multiple* / therapy
  • Adolescent
  • Brain Diseases* / diagnostic imaging
  • Brain Diseases* / etiology
  • Brain Diseases* / genetics
  • Brain Diseases* / therapy
  • Carbohydrate Metabolism, Inborn Errors / complications*
  • Carbohydrate Metabolism, Inborn Errors / diagnostic imaging
  • Carbohydrate Metabolism, Inborn Errors / genetics
  • Child, Preschool
  • Family Health
  • Female
  • Fetal Growth Retardation* / diagnostic imaging
  • Fetal Growth Retardation* / etiology
  • Fetal Growth Retardation* / genetics
  • Fetal Growth Retardation* / therapy
  • Humans
  • Ichthyosis* / diagnostic imaging
  • Ichthyosis* / etiology
  • Ichthyosis* / genetics
  • Ichthyosis* / therapy
  • Infant
  • Limb Deformities, Congenital* / diagnostic imaging
  • Limb Deformities, Congenital* / etiology
  • Limb Deformities, Congenital* / genetics
  • Limb Deformities, Congenital* / therapy
  • Male
  • Microcephaly / complications*
  • Microcephaly / diagnostic imaging
  • Microcephaly / etiology
  • Microcephaly / genetics
  • Microcephaly / therapy
  • Mutation / genetics*
  • Phenotype
  • Phosphoglycerate Dehydrogenase / deficiency*
  • Phosphoglycerate Dehydrogenase / genetics*
  • Psychomotor Disorders / complications*
  • Psychomotor Disorders / diagnostic imaging
  • Psychomotor Disorders / genetics
  • Seizures / complications*
  • Seizures / diagnostic imaging
  • Seizures / genetics
  • Serine / biosynthesis
  • Young Adult

Substances

  • Serine
  • Phosphoglycerate Dehydrogenase

Supplementary concepts

  • Neu Laxova syndrome
  • Phosphoglycerate Dehydrogenase Deficiency