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 Table of Contents  
LETTER TO EDITOR
Year : 2021  |  Volume : 13  |  Issue : 1  |  Page : 44-45

Dopa-responsive dystonia: Guanosine triphosphate cyclohydrolase 1, tyrosine hydroxylase, and sepiapterin reductase


Department of Medicine, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil

Date of Submission11-Mar-2021
Date of Acceptance12-Mar-2021
Date of Web Publication10-Apr-2021

Correspondence Address:
Dr. Jamir Pitton
Rua Roraima, Santa Maria, Rio Grande do Sul
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmbs.ijmbs_23_21

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How to cite this article:
Pitton J, Caprara AL. Dopa-responsive dystonia: Guanosine triphosphate cyclohydrolase 1, tyrosine hydroxylase, and sepiapterin reductase. Ibnosina J Med Biomed Sci 2021;13:44-5

How to cite this URL:
Pitton J, Caprara AL. Dopa-responsive dystonia: Guanosine triphosphate cyclohydrolase 1, tyrosine hydroxylase, and sepiapterin reductase. Ibnosina J Med Biomed Sci [serial online] 2021 [cited 2021 Jun 17];13:44-5. Available from: http://www.ijmbs.org/text.asp?2021/13/1/44/313509



Dear Editor,

We read the article entitled “Nephrocalcinosis in genetically proved dopa-responsive dystonia (DRD) due to sepiapterin reductase (SPR) deficiency in a Libyan girl” in this Journal with great interest. Etarhuni et al. reported the case of a female with DRD secondary to SPR deficiency who also presented nephrocalcinosis.[1] This unique characteristic was not already reported in other individuals affected by this pathology.

DRD is a very rare (1 in 1 million people) inherited type of dystonia that typically begins during childhood but may begin in adolescence or adulthood. DRD may be caused by the mutations in the guanosine triphosphate cyclohydrolase 1, tyrosine hydroxylase (TH), SPR genes, or the cause may be unknown. These genes are related to the enzymes that are associated with a common pathway responsible for the production of dopamine and serotonin (TH is not related).[2] The deficiency of dopamine can lead to a disbalance on the nigrostriatal area leading to dystonia and  Parkinsonism More Details, mainly in the lower limbs,[3] where the most common clinical manifestation is tip-toe walking. A special type of DRD is the Segawa disease (DYT5 dystonia), which is dopa-responsive generalized dystonia, caused by abnormalities of the gene GCH-1 located on chromosomes 14q22.1–q22.2.[2]

We provided [Figure 1] to remember the main metabolic pathway related to DRD. [Table 1] is a resume of the main characteristics of the DRD due to SPR deficiency cases from the Middle Eastern and North Africa region.[1],[4],[5] It is interesting to observe that the majority of the patients manifested symptoms during infancy and early childhood. The main clinical presentation was dystonia in the lower limbs, in which the majority had tiptoe walking. Some individuals had unique characteristics such as generalized Parkinsonism, postural tremor, fast fatigability, equinovarus deformity, oculogyric crisis, permanent limb hypertonia, mild cognitive delay, and bilateral nephrocalcinosis. It is worthy of mentioning that the earlier the disease begins, the greater the impairment; also, the cognitive decline is sometimes refractory to treatment.[5]
Table 1: Dopa-responsive dystonia due to sepiapterin reductase deficiency cases from the Middle Eastern and North Africa region

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Figure 1: Metabolic pathways of neurotransmitters related to DRD. GTP: guanosine triphosphate, NH2P3: dihydroneopterin triphosphate, 6PPH 4: 6 pyruvoyl tetrahydropterin, BH4: tetrahydrobiopterin, TYR: Tyrosine, 1: GTP cyclohydrase 1, 2: SPR, 3: Tyrosine hydroxylase

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The association of DRD due to SPR deficiency and nephrocalcinosis may be new, but the deposition of calcium in the renal parenchyma and dystonia was already reported with Lesch–Nyhan syndrome (hypoxanthine-guanine phosphoribosyl-transferase deficiency).[6] One clinical clue is the localization of dystonia because lower limbs are more commonly associated with DRD. Moreover, the presence of dystonia should be evaluated by a specialist to classify accordingly sometimes other diseases such as adrenoleukodystrophy can present with dystonia[7] or even the dystonia could be a benign finding that resolves without treatment.[8]

Authors' contributions

Equal.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Compliance with ethical principles

Not required.



 
  References Top

1.
Etarhuni SA, Zeglam AM, Elbouaishi AS, Sharfddin AM. Nephrocalcinosis in genetically proved dopa-responsive dystonia due to sepiapterin reductase deficiency in a Libyan Girl. Ibnosina J Med Biomed Sci 2020;12:315-9.  Back to cited text no. 1
  [Full text]  
2.
Mishra S, Mallick AK, Panigrahy D, Nayak P, Biswal NR. Series of dopa responsive dystonia masquerading as other diseases with short review. J Pediatr Neurosci 2020;15:421-5.  Back to cited text no. 2
  [Full text]  
3.
Rissardo JP, Caprara AL. Mirtazapine-associated movement disorders: A literature review. Tzu Chi Med J 2020;32:318-30.  Back to cited text no. 3
  [Full text]  
4.
Shalash AS, Rösler TW, Müller SH, Salama M, Deuschl G, Müller U, et al. c. 207C>G mutation in sepiapterin reductase causes autosomal dominant dopa-responsive dystonia. Neurol Genet 2017;3:e197.  Back to cited text no. 4
    
5.
AlSubhi S, AlShahwan S, AlMuhaizae M, AlZaidan H, Tabarki B. Sepiapterin reductase deficiency: Report of 5 new cases. Eur J Paediatr Neurol 2017;21:583-6.  Back to cited text no. 5
    
6.
Banerjee S, Sinha SK, Varshney PG, Ahuja P. Anaesthetic management of a child with Lesch Nyhan syndrome. Indian J Anaesth 2019;63:1051-2.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Rissardo JP, Caprara AL. Dystonia and adrenoleukodystrophy: An overview. Ann Mov Disord 2020;3:65-6.  Back to cited text no. 7
  [Full text]  
8.
Kulkarni SD, Kothari SR. Pediatric movement disorders and neuromodulation: An overview. Neurol India 2020;68:S206-12.  Back to cited text no. 8
[PUBMED]  [Full text]  


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