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Succinic semialdehyde dehydrogenase deficiency (SSADH-D) in an eleven-month-old infant with marked hypotonia and staring episodes: a case report Cover

Succinic semialdehyde dehydrogenase deficiency (SSADH-D) in an eleven-month-old infant with marked hypotonia and staring episodes: a case report

Open Access
|Sep 2022

Figures & Tables

Figure 1.

Magnetic resonance imaging of the brain. T2-weighted and FLAIR sequences with symmetrical hyperintensities of globus pallidi mainly in the anterior part (arrowhead) and delayed progress of the myelination with regards to the patient’s age.
Magnetic resonance imaging of the brain. T2-weighted and FLAIR sequences with symmetrical hyperintensities of globus pallidi mainly in the anterior part (arrowhead) and delayed progress of the myelination with regards to the patient’s age.

Figure 2.

EEG at the age of diagnosis, showed low voltage spikes mainly in the frontal area.
EEG at the age of diagnosis, showed low voltage spikes mainly in the frontal area.

Figure 3.

Chromatogram of urine organic acids of the patient with SSADH, by Gas Chromatography-Mass Spectrometry. The presence of the diagnostic metabolites 4-hydroxy-butyic, 3,4-dihydroxybutyric acid and 2,4-dihydroxybutyric acid confirm the characteristic pattern of the disease.
Chromatogram of urine organic acids of the patient with SSADH, by Gas Chromatography-Mass Spectrometry. The presence of the diagnostic metabolites 4-hydroxy-butyic, 3,4-dihydroxybutyric acid and 2,4-dihydroxybutyric acid confirm the characteristic pattern of the disease.

Figure 4.

Electropherograms depicting the parental heterozygosity as well as the patient’s homozygosity for the pathogenic variant.
Electropherograms depicting the parental heterozygosity as well as the patient’s homozygosity for the pathogenic variant.

Figure 5.

Interictal sleep EEG at the age of 2 ½ years old, with intermittent rhythmic delta activity (1–2Hz, up to 250 μV) mainly in parietal-occipital area bilaterally.
Interictal sleep EEG at the age of 2 ½ years old, with intermittent rhythmic delta activity (1–2Hz, up to 250 μV) mainly in parietal-occipital area bilaterally.

Figure 6.

Interictal sleep EEG, at the age of 4 years old, shows low voltage spikes mainly in frontal-temporal area bilaterally.
Interictal sleep EEG, at the age of 4 years old, shows low voltage spikes mainly in frontal-temporal area bilaterally.

Values of the metabolites of the child with SSADH_ Pathological values are shown in bold

MetaboliteBiological fluid/analysisValueReference value
4-hydroxy-butyricUrine/Organic acids688.7 mmol/mol creatininen.d.1
3,4- dihydroxybutyricUrine/Organic acids180 mmol/mol creatininen.d.1
2,4-dihydroxybutyricUrine/Organic acids30 mmol/mol creatininen.d.1
3-hydroxy-propionicUrine/Organic acids149.4 mmol/mol creatinine1.0–36.0 mmol/mol creatinine
2-hydroxy-glutaric2Urine/Organic acids76.8 mmol/mol creatinine0.0–15.0 mmol/mol creatinine
glutaric2Urine/Organic acids36.2 mmol/mol creatinine0.0–5.3 mmol/mol creatinine
glycinePlasma/AminoacidsCSF/Aminoacids289.0 μmol/L4.0 μmol/L107.0–343 μmol/L3.7–7.6 μmol/L
5-hydroxy-indoloaceticCSF/ Biogenic amines184.0 nmol/L170.0–490.0 nmol/L
homovanillicCSF/ Biogenic amines630.0 nmol/L344.0–906.0 nmol/L
3-ortho-methyldopaCSF/ Biogenic amines20.0 nmol/L4.0–50.0 nmol/L
5-hydroxy-tryptophanCSF/ Biogenic amines7.0 nmol/L1.6–15.0 nmol/L
neopterinCSF/ Pterins31.08.0–43.0 nmol/L
biopterinCSF/ Pterins41.08.0–54.0 nmol/L
DOI: https://doi.org/10.2478/joepi-2022-0003 | Journal eISSN: 2299-9728 | Journal ISSN: 2300-0147
Language: English
Submitted on: Feb 14, 2022
Accepted on: Aug 1, 2022
Published on: Sep 5, 2022
Published by: The Foundation of Epileptology
In partnership with: Paradigm Publishing Services
Publication frequency: 2 issues per year

© 2022 Stella Mouskou, Katherine Anagnostopoulou, Danae Bikouli, Efstathia Paramera, Evangelos Papakonstantinou, Anastasia Korona, Vasiliki Ziaka, Mirsini Mavrikou, Anastasia Skouma, published by The Foundation of Epileptology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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