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Is Hyperprolinemia Type I Actually a Benign Trait? Report of a Case With Severe Neurologic Involvement and Vigabatrin Intolerance

Service de Neurologie Pédiatrique

François Rivier, MD

Service de Neurologie Pédiatrique

Agathe Roubertie, MD

Service de Neurologie Pédiatrique

Bernard Echenne, MD

Service de Neurologie Pédiatrique

Helène Bellet, MD

Laboratoire de Biochimie B

Catherine Vallat, MD

Laboratoire de Biochimie B

Denis Morin, MD

Service de Pediatrie CHU Saint Eloi Montpellier, France

Hyperprolinemia type I is a deficiency of proline oxidase (McKusick 23950), leading to hyperprolinemia and iminoglycinuria, usually with renal involvement. Hyperprolinemia type I is considered a benign trait. We reported a case of hyperprolinemia type I with a severe neurologic disorder and without renal involvement. The patient had marked psychomotor delay and right hemiparesis. Epilepsy was characterized by status epilepticus or a cluster of seizures. Laboratory findings revealed elevated levels of proline in the serum, urine, and cerebrospinal fluid without ¹-pyrroline 5-carboxylate dehydrogenase in the plasma or urine. Fluorescence in situ hybridization excluded a chromosome 22q11 deletion. Vigabatrin inhibits ornithine transaminase. Thus, vigabatrin could lead to a depletion of the normal pool of pyrroline 5-carboxylate dehydrogenase and could aggravate the clinical condition of the child. In this study, vigabatrin was discontinued. In the following months, the patient had marked psychomotor improvement, without modification of the epilepsy. We suggest that vigabatrin should be avoided in hyperprolinemia type I. (J Child Neurol 2001; 16:622-623)

Journal of Child Neurology, Vol. 16, No. 8, 622-623 (2001)
DOI: 10.1177/088307380101600820


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