Evaluation of CSF Neurotransmitters and Folate in 25 Patients with Rett Disorder and Effects of Treatment

• Autor(a) principal: Temudo, T
• Data de Publicação: 2009
• Outros Autores: Rios, M, Prior, C, Carrilho, I, Santos, M, Maciel, P, Sequeiros, J, Fonseca, M, Monteiro, J, Cabral, P, Vieira, JP, Ormazabal, A, Artuch, R
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.17/2336
• topic: Folic Acid/cerebrospinal fluid; Leucovorin/therapeutic use; Neurotransmitter Agents/cerebrospinal fluid; Rett Syndrome/cerebrospinal fluid; Rett Syndrome/drug therapy; Administration, Oral; Folic Acid/analogs & derivatives; Fluoxetine/therapeutic use; Fluoxetine/administration & dosage; Homovanillic Acid/cerebrospinal fluid; Hydroxyindoleacetic Acid/cerebrospinal fluid; Leucovorin/administration & dosage; Methyl-CpG-Binding Protein 2/genetics; Polymerase Chain Reaction; Rett Syndrome/genetics; Seizures/drug therapy; Serotonin Uptake Inhibitors/administration & dosage; Stereotyped Behavior/drug effects; Treatment Outcome; Vitamin B Complex/therapeutic use; Child; HDE NEU PED

Background: Rett disorder (RD) is a progressive neurodevelopmental entity caused by mutations in the MECP2 gene. It has been postulated that there are alterations in the levels of certain neurotransmitters and folate in the pathogenesis of this disease. Here we re-evaluated this hypothesis. Patients and Methods: We evaluated CSF folate, biogenic amines and pterines in 25 RD patients. Treatment with oral folinic acid was started in those cases with low folate. Patients were clinically evaluated and videotaped up to 6 months after therapy. Results: CSF folate was below the reference values in 32% of the patients. Six months after treatment no clinical improvement was observed. Three of the four patients with the R294X mutation had increased levels of a dopamine metabolite associated to a particular phenotype. Three patients had low levels of a serotonin metabolite. Two of them were treated with fluoxetine and one showed clinical improvement. No association was observed between CSF folate and these metabolites, after adjusting for the patients age and neopterin levels. Conclusion: Our results support that folinic acid supplementation has no significant effects on the course of the disease. We report discrete and novel neurotransmitter abnormalities that may contribute to the pathogenesis of RD highlighting the need for further studies on CSF neurotransmitters in clinically and genetically well characterized patients.