Movement Disorders in Treatable Inborn Errors of Metabolism

Mov Disord. 2019 May;34(5):598-613. doi: 10.1002/mds.27568. Epub 2018 Dec 17.

Abstract

There are several hundred single-gene disorders that we classify as inborn errors of metabolism. Inborn errors of metabolism are often rare and highly heterogeneous multisystem diseases with non-neurological and neurological manifestations, commonly with onset during childhood. Movement disorders are among the most common neurological problems in inborn errors of metabolism, but, in many cases, remain poorly defined. Although movement disorders are usually not the only and often not the presenting symptom, their recognition can facilitate a diagnosis. Movement disorders contribute substantially to the morbidity in inborn errors of metabolism and can have a significant impact on quality of life. Common metabolic movement disorders include the monoamine neurotransmitter disorders, disorders of amino and organic acid metabolism, metal storage disorders, lysosomal storage disorders, congenital disorders of autophagy, disorders of creatine metabolism, vitamin-responsive disorders, and disorders of energy metabolism. Importantly, disease-modifying therapies exist for a number of inborn errors of metabolism, and early recognition and treatment can prevent irreversible CNS damage and reduce morbidity and mortality. A phenomenology-based approach, based on the predominant movement disorder, can facilitate a differential diagnosis and can guide biochemical, molecular, and imaging testing. The complexity of metabolic movement disorders demands an interdisciplinary approach and close collaboration of pediatric neurologists, neurologists, geneticists, and experts in metabolism. In this review, we develop a general framework for a phenomenology-based approach to movement disorders in inborn errors of metabolism and discuss an approach to identifying the "top ten" of treatable inborn errors of metabolism that present with movement disorders-diagnoses that should never be missed. © 2018 International Parkinson and Movement Disorder Society.

Keywords: inborn errors of metabolism; movement disorders; neurogenetics; neurotransmitter disorders; treatment.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Amino Acid Metabolism, Inborn Errors / complications
  • Amino Acid Metabolism, Inborn Errors / diagnosis
  • Amino Acid Metabolism, Inborn Errors / physiopathology
  • Amino Acid Metabolism, Inborn Errors / therapy
  • Ataxia / complications
  • Ataxia / diagnosis
  • Ataxia / etiology
  • Ataxia / physiopathology
  • Ataxia / therapy
  • Basal Ganglia Diseases / complications
  • Basal Ganglia Diseases / diagnosis
  • Basal Ganglia Diseases / physiopathology
  • Basal Ganglia Diseases / therapy
  • Brain Diseases, Metabolic / complications
  • Brain Diseases, Metabolic / diagnosis
  • Brain Diseases, Metabolic / physiopathology
  • Brain Diseases, Metabolic / therapy
  • Carbohydrate Metabolism, Inborn Errors / complications
  • Carbohydrate Metabolism, Inborn Errors / diagnosis
  • Carbohydrate Metabolism, Inborn Errors / physiopathology
  • Carbohydrate Metabolism, Inborn Errors / therapy
  • Chorea / etiology
  • Chorea / physiopathology
  • Dystonia / etiology
  • Dystonia / physiopathology
  • Dystonic Disorders / complications
  • Dystonic Disorders / diagnosis
  • Dystonic Disorders / etiology
  • Dystonic Disorders / physiopathology
  • Dystonic Disorders / therapy
  • Folic Acid Deficiency / complications
  • Folic Acid Deficiency / diagnosis
  • Folic Acid Deficiency / physiopathology
  • Folic Acid Deficiency / therapy
  • Glutaryl-CoA Dehydrogenase / deficiency
  • Hepatolenticular Degeneration / complications
  • Hepatolenticular Degeneration / diagnosis
  • Hepatolenticular Degeneration / physiopathology
  • Hepatolenticular Degeneration / therapy
  • Humans
  • Metabolic Diseases / complications
  • Metabolic Diseases / diagnosis
  • Metabolic Diseases / physiopathology
  • Metabolic Diseases / therapy
  • Metabolism, Inborn Errors / complications
  • Metabolism, Inborn Errors / diagnosis
  • Metabolism, Inborn Errors / physiopathology*
  • Metabolism, Inborn Errors / therapy
  • Monosaccharide Transport Proteins / deficiency
  • Movement Disorders / etiology
  • Movement Disorders / physiopathology*
  • Muscle Spasticity / etiology
  • Muscle Spasticity / physiopathology
  • Myoclonus / etiology
  • Myoclonus / physiopathology
  • Niemann-Pick Disease, Type C / complications
  • Niemann-Pick Disease, Type C / diagnosis
  • Niemann-Pick Disease, Type C / physiopathology
  • Niemann-Pick Disease, Type C / therapy
  • Parkinsonian Disorders / etiology
  • Parkinsonian Disorders / physiopathology
  • Vitamin E Deficiency / complications
  • Vitamin E Deficiency / diagnosis
  • Vitamin E Deficiency / physiopathology
  • Vitamin E Deficiency / therapy
  • Xanthomatosis, Cerebrotendinous / complications
  • Xanthomatosis, Cerebrotendinous / diagnosis
  • Xanthomatosis, Cerebrotendinous / physiopathology
  • Xanthomatosis, Cerebrotendinous / therapy

Substances

  • Monosaccharide Transport Proteins
  • Glutaryl-CoA Dehydrogenase

Supplementary concepts

  • Ataxia with vitamin E deficiency
  • Basal ganglia disease, biotin-responsive
  • Dystonia 18
  • Dystonia, Dopa-responsive
  • Glut1 Deficiency Syndrome
  • Glutaric Acidemia I
  • Hypermanganesemia with Dystonia Polycythemia and Cirrhosis