Myoclonic tremor status as a presenting symptom of adenylosuccinate lyase deficiency.

Adenylosuccinate lyase deficiency is a rare autosomal recessive disorder of purine metabolism. The disorder manifests with developmental delay, postnatal microcephaly, hypotonia, involuntary movements, epileptic seizures, ataxia and autistic features. Paroxysmal non-epileptic motor events are not a typical presentation of the disease. We describe an 8-year-old boy who presented with an infantile onset of prolonged episodes of multifocal sustained myoclonic tremor lasting from minutes to days on a background of global developmental delay and gait ataxia. Ictal EEG during these episodes was normal. Ictal surface EMG of the involved upper limb showed a muscular activation pattern consistent with cortical myoclonus. Brain MRI showed mild cerebral atrophy. Whole exome sequencing revealed a novel homozygous variant in the ADSL gene: c.1027G > A; p. Glu343Lys, inherited from each heterozygous parent. There was a marked elevation of urine succinyladenosine, confirming the diagnosis of adenylosuccinate lyase deficiency. In conclusion, myoclonic tremor status expands the spectrum of movement disorders seen in adenylosuccinate lyase deficiency. Copyright © 2020 Elsevier Masson SAS. All rights reserved.

Citation

Michal M Andelman-Gur, Hirotomo Saitsu, Naomichi Matsumoto, Ronen Spiegel, Keren Yosovich, Dorit Lev, Tally Lerman-Sagie, Lubov Blumkin. Myoclonic tremor status as a presenting symptom of adenylosuccinate lyase deficiency. European journal of medical genetics. 2020 Dec;63(12):104061

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PMID: 32890691

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