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  • 1
    ISSN: 1573-2665
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The study included 16 adolescents with optimally controlled hyperphenylalaninaemia (McKusick 26160), of whom six did not require treatment according to conventional criteria. All except the two patients with lowest median serum phenylalanine level throughout childhood (most values at 200–300 µmol/L) had white matter abnormalities detectable with magnetic resonance imaging. The lesions were particularly prominent in the watershed regions between the posterior and middle cerebral arteries. In most patients with moderate or severe hyperphenylalaninaemia frontal white matter lesions were present as well. Normal proton magnetic resonance spectra indicated that the lesions were stable. Occipital EEG abnormalities were frequent, and deficient performance on a pattern-recognition test was a characteristic neuropsychological finding. Serum phenylalanine levels at about 300 µmol/L or below throughout childhood and early adolescence may be required to avoid lesions. The present study demonstrates the limitations of even an optimally controlled dietary regimen in hyperphenylalaninaemia.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1573-2665
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Conclusion Phenylalanine hydroxylase deficiency results in a fairly continuous spectrum of metabolic phenotypes, which can now be predicted by means of molecular analysis. Methods for direct detection of previously identified mutations and mutation scanning techniques (SSCP and DGGE) have facilitated genotyping of the hyperphenylalaninaemic neonate. Genotyping will confirm that the hyperphenylalaninaemic neonate has PAH deficiency and not a BH4-deficient form of hyperphenylalaninaemia or acquired hyperphenylalaninaemia. Genotyping will also distinguish between non-PKU HPA neonates and PKU patients. Finally, genotyping predicts the metabolic phenotype, facilitating optimal dietary therapy from the neonatal period. A possible relationship between mutation genotype and the ultimate prognosis of PKU (MRI changes, cognitive development), and the question of whether the maternal genotype and the mutant allele of her offspring may influence pregnancy outcome are challenges for future studies.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1573-2665
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A survey is given of literature reports on the effect of performance in offspring from 26 maternal PKU pregnancies treated prior to conception. The survey includes two women who were referred to us for genetic counselling because they had both given birth to microcephalic, mentally retarded children. The women were discovered to suffer from unrecognized maternal PKU with fasting phenylalanine concentration of 1.1–1.5mmol/L. A strict diet was introduced prior to planned pregnancy and after some months on diet (phenylalanine concentrations 〈0.6 mmol/L) they became pregant again. Serum phenylalanine levels were monitored weekly throughout pregnancy, and adjustments in the diet were made to keep serum phenylalanine concentration within the range of 0.18–0.42 mmol/L. The outcome of the pregnancies were healthy children who have developed normally. Their IQs are 105 and 119 at ten and four years of age, respectively and their head circumferences are normal. Our data show that the effect of preconceptional dietary treatment was children with a normal performance, contrary to their older siblings born following untreated pregnancies. These results are in agreement with the survey of ten years' promising experiences with preconceptional treatment in maternal PKU. The data may help to motivate young PKU women to accept planned pregnancies and to encourage them to return to the strict diet, which has prevented them from being retarded.
    Type of Medium: Electronic Resource
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