What Is Not in the Name? Dopa-Responsive Dystonia May Respond to More Than L-Dopa.

Abstract:

BACKGROUND:Classic L-dopa-responsive dystonia is characterized by the triad of dystonia, diurnal fluctuation of signs, and dramatic response of signs to low-dose L-dopa therapy. Dopa-responsive dystonia succinctly summarizes the relevant clinical features. However, literal application of this label or consideration of dopa-responsive dystonia as a diagnostic end without molecular and/or biochemical definition may contribute to misdiagnosis and incomplete treatment in dopa-responsive conditions that impair synthesis of monoamine neurotransmitters besides dopamine. PATIENT DESCRIPTION:We describe and provide video for twin patients with a rare form of dopa-responsive dystonia due to sepiapterin reductase deficiency. As is typical in dopa-responsive dystonia, these patients displayed dramatic improvement with L-dopa/carbidopa therapy. However, treatment was suboptimal until 5-hydroxytryptophan was added to address their serotonergic deficit. DISCUSSION:Our report highlights the limitations of the dopa-responsive dystonia label and increases awareness of sepiapterin reductase deficiency and other conditions that may present as dopa-responsive dystonia. We provide a diagnostic and therapeutic approach to guide the clinician in evaluating and treating individuals with dopa-responsive dystonia.

journal_name

Pediatr Neurol

journal_title

Pediatric neurology

authors

Friedman JR

doi

10.1016/j.pediatrneurol.2015.12.016

subject

Has Abstract

pub_date

2016-06-01 00:00:00

pages

76-80

eissn

0887-8994

issn

1873-5150

pii

S0887-8994(15)30271-X

journal_volume

59

pub_type

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